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1.
Orthopade ; 43(4): 374-8, 2014 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-24658883

RESUMEN

BACKGROUND: Proximal femoral focal deficiency (PFFD) types II and III (Pappas) have no femoral or only abortive femoral head development. Winkelmann published a case of one patient treated with a modification of rotation plasty by creating a new articulation after 180° rotation of the lower leg and insertion of the lateral tibial plateau into the deficient acetabulum. This article reports on three consecutive patients treated with this technique to validate this procedure and to consider this operation in selected patients. PATIENTS AND METHODS: At the time of rotation plasty the patients (2 boys and 1 girl) were aged between 5 and 10 years. The observation period is between 5 and 9 years after surgery. All patients used an orthoprosthesis with full contact in the foot region and a shaft connecting the thigh. A hip basket and any additional walking support were not necessary (e.g. canes). They were all highly satisfied and would choose the same treatment again. CONCLUSION: Rotation plasty is a technically highly demanding procedure, especially in situations such as PFFD where the anatomy is distorted and structures such as blood vessels and nerves are too short. However, it is an option to improve the orthoprosthetic fitting functionally and esthetically.


Asunto(s)
Artroplastia/métodos , Miembros Artificiales , Luxación Congénita de la Cadera/cirugía , Inestabilidad de la Articulación/cirugía , Tratamientos Conservadores del Órgano/métodos , Procedimientos de Cirugía Plástica/métodos , Recuperación de la Función , Artroplastia/instrumentación , Niño , Preescolar , Femenino , Luxación Congénita de la Cadera/diagnóstico , Humanos , Inestabilidad de la Articulación/diagnóstico , Masculino , Tratamientos Conservadores del Órgano/instrumentación , Procedimientos de Cirugía Plástica/instrumentación , Resultado del Tratamiento
2.
Ann Oncol ; 22(5): 1228-1235, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21030381

RESUMEN

BACKGROUND: Local recurrence (LR) in osteosarcoma is associated with very poor prognosis. We sought to evaluate which factors correlate with LR in patients who achieved complete surgical remission with adequate margins. PATIENTS AND METHODS: We analyzed 1355 patients with previously untreated high-grade central osteosarcoma of the extremities, the shoulder and the pelvis registered in neoadjuvant Cooperative Osteosarcoma Study Group trials between 1986 and 2005. Seventy-six patients developed LR. RESULTS: Median follow-up was 5.56 years. No participation in a study, pelvic tumor site, limb-sparing surgery, soft tissue infiltration beyond the periosteum, poor response to neoadjuvant chemotherapy, failure to complete the planned chemotherapy protocol and biopsy at a center other than the one performing the tumor resection were significantly associated with a higher LR rate. No differences were found for varying surgical margin widths. Surgical treatment at centers with small patient volume and additional surgery in the primary tumor area, other than biopsy and tumor resection, were significantly associated with a higher rate of ablative surgery. CONCLUSIONS: Patient enrollment in clinical trials and performing the biopsy at experienced institutions capable of undertaking the tumor resection without compromising the oncological and functional outcome should be pursued in the future.


Asunto(s)
Recurrencia Local de Neoplasia/prevención & control , Osteosarcoma/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Terapia Neoadyuvante , Recurrencia Local de Neoplasia/mortalidad , Osteosarcoma/tratamiento farmacológico , Osteosarcoma/mortalidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
3.
J Child Orthop ; 5(4): 261-6, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22852032

RESUMEN

BACKGROUND: The purpose of this study was to analyze whether hips treated for developmental dysplasia of the hip (DDH) during infancy, which were clinically and radiologically fully normalized by walking age, may become dysplastic again during later growth. MATERIALS AND METHODS: A total of 150 patients were randomly selected out of a collective of 386 patients treated for DDH at the Department of Orthopaedics at the University of Zurich between 1993 and 2004. Treatment was started at birth and continued for 6 months. All patients had clinically and radiographically normal hips by walking age. The patients did not suffer from other diseases, in particular, neurological or neuromuscular diseases. RESULTS: We detected four female subjects among the 150 patients who had been successfully treated for DDH, who had developed dysplastic hips in early adolescence, necessitating acetabular surgery. CONCLUSION: The successful treatment of DDH in infancy does not ensure normal hip development; therefore, follow up into maturity may be recommended. LEVEL OF EVIDENCE: Level IV.

4.
Orthopade ; 36(6): 582, 584-7, 2007 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-17443312

RESUMEN

BACKGROUND: A major problem in lengthening a short femur in proximal focal deficiency of the femur (PFFD) is the development of contractures and dislocation of the hip and knee joint. The knee joint is particularly prone to dislocation because of the cruciate ligament insufficiency associated with PFFD. Axis deviations also need specific attention. PATIENTS AND METHODS: In four patients (age 2.5-11 years) with PFFD (PAPPAS class III in one patient and VII in three patients), five femoral lengthenings with mechanical axis corrections were performed by the callotasis technique using a hybrid fixation system (Monotube/Triax) connecting the femur and the tibia with a fixed hinged knee joint to protect the knee against contracture and dislocation. RESULTS: All patients retained their hip and knee function. Hip flexion contracture during lengthening may make inclusion of the hip joint into the fixation system necessary, but was not carried out in the four patients presented. CONCLUSION: Four consecutive lengthenings of the femur with focal deficiency were carried out under protection by a hinged knee bridging external fixator. A dislocation could be prevented in all patients. We consider that such a system could be used during these lengthening procedures.


Asunto(s)
Alargamiento Óseo/métodos , Fijadores Externos , Fémur/anomalías , Fémur/cirugía , Inestabilidad de la Articulación , Luxación de la Rodilla/prevención & control , Articulación de la Rodilla , Diferencia de Longitud de las Piernas/cirugía , Alargamiento Óseo/instrumentación , Niño , Preescolar , Femenino , Fémur/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/prevención & control , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiología , Diferencia de Longitud de las Piernas/diagnóstico por imagen , Masculino , Radiografía , Factores de Tiempo , Resultado del Tratamiento
5.
Artículo en Inglés | MEDLINE | ID: mdl-17065124

RESUMEN

We covered a transfemoral amputation stump with a modified free filet flap including the calcaneus. The flap survived, resulting in lengthening of the femur, improved distal weight-bearing, preserved sensitivity of the stump, and the design of a prosthesis with terminal loading of the femur rather than an ischial contained prosthesis.


Asunto(s)
Muñones de Amputación/inervación , Muñones de Amputación/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/inervación , Soporte de Peso , Adulto , Amputación Quirúrgica , Miembros Artificiales , Neoplasias Óseas/cirugía , Fémur/cirugía , Humanos , Osteosarcoma/cirugía , Ajuste de Prótesis , Sensación
6.
Eur J Pediatr Surg ; 16(4): 294-6, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16981101

RESUMEN

During the dissection of seven club feet of foetuses, aborted between the 25th and 37th week of gestation, an additional muscle bundle was found in a right foot. This muscle arose from both heads of the gastrocnemius muscle, continued downwards onto the posterior surface of the soleus, crossed the calcaneal tendon and assumed a position on the lateral side of the calcaneal tendon. The muscle's tendon was fixed just laterally to the calcaneal tendon in the calcaneal tuberosity with some tiny fibres branching off into the superior fibular retinaculum.


Asunto(s)
Pie Equinovaro/patología , Músculo Esquelético/anomalías , Pie Equinovaro/embriología , Feto , Humanos , Tendones/patología
7.
Infection ; 34(2): 81-6, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16703297

RESUMEN

BACKGROUND: Successful treatment of allograft infections by the temporary implantation of an antibiotic-loaded polymethylmethacrylate cement spacer depends on the diffusion of antibiotics out of the cement and inhibition of bacterial growth in the surrounding tissue. We investigated with an in vitro model how long antibiotics are released by the cement and if gentamicin-resistant coagulase-negative staphylococci (CNS) are inhibited by vancomycin mixed with the gentamicin-loaded cement. MATERIALS AND METHODS: Four formulations of antibiotic-loaded cement disks, i.e. gentamicin, tobramycin, vancomycin and tobramycin combined with vancomycin, respectively, were used to test the inhibition of eight isolates of Staphylococcus epidermidis and two reference strains of Staphylococcus aureus by an agar diffusion test on Mueller-Hinton (MH) agar similar to the routine laboratory disk diffusion method. Moreover, cement spacer cylinders loaded with gentamicin alone or combined with vancomycin were submerged in MH agar for weeks and the capacity to inhibit five different isolates of S. epidermidis was measured. RESULTS: The size of the inhibition zones around the antibiotic-loaded cement disks correlated with the minimal inhibitory concentration (MIC) of the antibiotics against the tested strains. All five strains of S. epidermidis were inhibited by vancomycin-loaded cement spacers for at least 30 days. However, two gentamicin-resistant S. epidermidis strains with MICs of 4 mg/l and 16 mg/l could not be inhibited longer than 3 days by the gentamicin-loaded cement spacer. CONCLUSION: The in vitro data suggest that antibiotic-loaded cement spacers inhibit susceptible bacteria for 4-6 weeks. The addition of vancomycin to commercial aminoglycoside-loaded cements might be helpful in allograft infections in tumor patients to inhibit a broad range of bacteria including gentamicin-resistant CNS very commonly found in such infections.


Asunto(s)
Aminoglicósidos/farmacología , Antibacterianos/farmacología , Coagulasa/metabolismo , Staphylococcus aureus/efectos de los fármacos , Staphylococcus epidermidis/efectos de los fármacos , Vancomicina/farmacología , Aminoglicósidos/administración & dosificación , Antibacterianos/administración & dosificación , Cementos para Huesos/química , Sistemas de Liberación de Medicamentos , Farmacorresistencia Bacteriana , Sinergismo Farmacológico , Gentamicinas/administración & dosificación , Gentamicinas/farmacología , Humanos , Resistencia a la Meticilina , Pruebas de Sensibilidad Microbiana , Polimetil Metacrilato/química , Staphylococcus aureus/enzimología , Staphylococcus epidermidis/enzimología , Factores de Tiempo , Vancomicina/administración & dosificación
8.
Orthopade ; 35(9): 989-92, 2006 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-16622705

RESUMEN

BACKGROUND: The CT-guided therapy of osteoid osteoma instead of older methods such as open resection has the advantage of exact localization of the nidus intraoperatively and exact documentation of its ablation. Another advantage is the less invasive approach. PATIENTS AND METHODS: A total of 52 patients with osteoid osteoma were treated in our institution between 1996 and 2005 either by radiofrequency ablation (n=11) or by percutaneous resection under CT guidance (n=41). Their age was between 7 and 48 years, mean age was 22.3 years, and follow-up was 31.3 months. RESULTS: In all patients (n=52) the osteoid osteoma was successfully treated. In 50 patients the first treatment resulted in long-term success. In two patients the nidus was first missed; they were successfully treated with another operation using the same technique. CONCLUSION: The CT-guided operation of osteoid osteoma made the therapy much easier because of the exact localization and the less invasive approach. This technique can be used analogously to tumor biopsy. The advantage is the exact documentation of the biopsy path and the possibility to take specimens.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Ablación por Catéter/métodos , Osteoma Osteoide/diagnóstico por imagen , Osteoma Osteoide/cirugía , Osteotomía/métodos , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Niño , Humanos , Masculino , Persona de Mediana Edad , Radiografía Intervencional/métodos , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento
9.
J Bone Joint Surg Br ; 88(1): 95-9, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16365128

RESUMEN

The outcome of tibial allograft reconstruction after resection of a tumour is inconsistent and has a high rate of failure. There are few reports on the use of tibial allografts in children with open growth plates. We performed 21 allograft reconstructions (16 osteoarticular, five intercalary) in 19 consecutive patients between seven and 17 years of age. Two had Ewing's sarcoma, one an adamantinoma and 16 osteosarcoma, one with multifocal disease. Five patients have died; the other 14 were free from disease at the time of follow-up. Six surviving patients (eight allograft reconstructions) continue to have good or excellent function at a mean of 59 months (14 to 132). One patient has poor function at 31 months. The other seven patients have a good or excellent function after additional procedures including exchange of the allograft and resurfacing or revision to an endoprosthesis at a mean of 101 months (43 to 198). The additional operations were performed at a mean of 47 months (20 to 84) after the first reconstruction. With the use of allograft reconstruction in growing children, joints and growth plates may be preserved, at least partially. Although our results remain inconsistent, tibial allograft reconstruction in selected patients may restore complete and durable function of the limb.


Asunto(s)
Neoplasias Óseas/cirugía , Trasplante Óseo/métodos , Osteosarcoma/cirugía , Tibia/cirugía , Adamantinoma/cirugía , Adolescente , Trasplante Óseo/rehabilitación , Niño , Femenino , Estudios de Seguimiento , Humanos , Diferencia de Longitud de las Piernas/etiología , Masculino , Radiografía , Reoperación/métodos , Sarcoma de Ewing/cirugía , Tibia/diagnóstico por imagen , Resultado del Tratamiento , Cicatrización de Heridas
10.
J Orthop Res ; 23(5): 1065-72, 2005 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-15890487

RESUMEN

INTRODUCTION: Extensively porous coated segmental replacement prostheses with intramedullary cementless fixation to bone over the whole length of stem often exhibit resorption of the surrounding bone due to stress-shielding. This makes them particularly susceptible to aseptic loosening. STUDY: A finite element analysis of the state of loading of a short-length fixation in a new prosthetic stem design has shown a definite advantage over long-length fixation. The stress pattern within the bone surrounding the prosthesis confirmed that shortening of the ongrowth area in length increases the stress values at the resection level significantly. This stem (Endlock) has been used for diaphyseal anchorage in the treatment of tumors in combination with an artificial joint of proven design in order to reduce stress shielding. RESULTS: No Endlock stem fractures or aseptic loosenings were observed at recent follow-up. The early clinical results comply with the theoretical assumptions. CONCLUSIONS: A short-length fixation system based on intramedullary anchorage of segmental replacement endoprostheses would possibly support physiologic adaptive processes more than fixation over the full length of the stem.


Asunto(s)
Artroplastia de Reemplazo/métodos , Neoplasias Óseas/cirugía , Diáfisis/cirugía , Análisis de Elementos Finitos , Diseño de Prótesis , Adulto , Anciano , Neoplasias Óseas/patología , Neoplasias Óseas/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estrés Mecánico , Anomalía Torsional
11.
Foot Ankle Int ; 25(2): 53-8, 2004 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-14992702

RESUMEN

Four patients with malignant tumors of the proximal toe phalanx who had closed contact or direct involvement of the metatarsophalangeal joints or direct infiltration of the metatarsal bone were treated. Treatment included ray resection and reconstruction either by free microvascular fibula transfer, intermetatarsal bony fusion, or soft-tissue stabilization. Foot function was analyzed by Novel pedobarography. The four patients with a follow-up between 21 months and 8 years show almost normal gait. All patients have remained relapse free. If adequate margins can be achieved, ray resection and appropriate reconstruction may be an alternative to amputation.


Asunto(s)
Neoplasias Óseas/cirugía , Huesos del Pie/cirugía , Huesos Metatarsianos/cirugía , Sarcoma/cirugía , Adolescente , Adulto , Anciano , Neoplasias Óseas/fisiopatología , Niño , Femenino , Pie/fisiopatología , Marcha , Humanos , Masculino , Articulación Metatarsofalángica/cirugía , Presión , Procedimientos de Cirugía Plástica , Sarcoma/fisiopatología
12.
Skeletal Radiol ; 31(12): 724-9, 2002 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-12483436

RESUMEN

A case of Gorham-Stout disease of the shoulder girdle and cervico-thoracic spine in a 65-year-old woman is described. The patient presented with progressive neurologic symptoms, pain, and deformities of the cervico-thoracic spine as well as of her left shoulder following a traumatic shoulder luxation. Since the patient had a history of uterine carcinoma, the current disease was clinically difficult to differentiate from osteolytic metastases. The results of the clinical, radiological and histopathologic examination leading to the diagnosis of Gorham-Stout disease are described. Neither attempted surgery nor radiotherapy produced clinical improvement and the patient died 1 year after the first clinical evaluation.


Asunto(s)
Osteólisis Esencial/diagnóstico , Anciano , Vértebras Cervicales/patología , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Magnética , Osteólisis Esencial/terapia , Articulación del Hombro/patología , Vértebras Torácicas/patología , Tomografía Computarizada por Rayos X
13.
Orthopade ; 31(9): 857-65, 2002 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-12232703

RESUMEN

In looking at the pathoanatomy of slipped capital epiphysis, it is important to appreciate that the articular cartilage ruptures at the level of the physis as the articular cartilage also covers part of the femoral neck metaphysis. As a consequence, smoothness is lost and already with mild slips the irregularities may injure the acetabular cartilage structures and may cause tears of the labrum. Principally therefore an open revision and restoration of the anatomy as perfectly as possible is needed. The technique for open reduction was developed by Dunn in 1964 and then refined by Ganz in 1997 applying new anatomical vascular studies. However, the long-term data on the "conservative" approach of only using transfixation to avoid further slipping show relatively good results and long-term studies of a more aggressive open approach will be needed to show evidence of further improvement. For the more severe cases, restoration of the correct anatomy by open reduction or improved axial relationships by more distant osteotomies have already been proven to give better results. Besides the extent of the slip, it is important to consider whether the slip is acute or chronic or acute and chronic. So far there are no data showing that the surgical treatment of slipped capital femoral epiphysis must be made on an emergency basis. However, prevention of further slips, e.g., by supine transport, is to be considered an emergency.


Asunto(s)
Epífisis Desprendida/cirugía , Cabeza Femoral/cirugía , Adolescente , Tornillos Óseos , Hilos Ortopédicos , Cartílago Articular/patología , Cartílago Articular/cirugía , Niño , Epífisis Desprendida/diagnóstico , Epífisis Desprendida/patología , Femenino , Cabeza Femoral/patología , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Imagen por Resonancia Magnética , Masculino , Osteotomía/métodos , Rotura Espontánea
14.
Orthopade ; 31(9): 900-7, 2002 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-12232709

RESUMEN

The progression of degenerative changes of the hip after slipped capital femoral epiphysis (SCFE) largely correlates with the patient's age at the time the deformity occurs and with the degree of the epiphyseal gliding. From the pathogenetic point of view, the altered biomechanical conditions of the hip joint with deformation of the proximal femur may result in an impingement of the femoral neck metaphysis against the anterior acetabular rim. Observations of the "natural course" or after "in situ fixation" of the epiphysis show the development of secondary hip arthritis at an average of 20 years after SCFE, specifically in slips with more than 30 degrees of epiphyseal gliding. The intertrochanteric osteotomy as introduced by G. Imhäuser aims at restoring joint congruity to reduce the prearthrotic deformity and thus to decrease the incidence of later hip arthritis. The reorientation of the predominantly posteriorly slipped femoral epiphysis is achieved by an intertrochanteric flexion osteotomy, which reduces the potential for femoroacetabular impingement. On the basis of a long-term evaluation, the indication for and results of an intertrochanteric osteotomy for chronic unilateral SCFE were presented. Of the 51 patients operated on between 1962 and 1972 and examined clinically and radiographically at an average follow-up time of 24 years (20-29 years) after osteotomy, 55% showed a hip free of degenerative changes, 28% had developed moderate degenerative changes, and 17% had advanced arthritis. Aside from a few technical errors, the correction at the intertrochanteric level for moderate slips proved to be a safe procedure regarding risk for femoral head necrosis. The long-term development after SCFE is most important for patients with SCFE. More than half of the patients have hip joints free of degenerative changes more than 20 years after intertrochanteric osteotomy according to G. Imhäuser, which compares favorably to the "natural course" or to "in situ fixation" and which supports the indication for this corrective procedure in SCFE.


Asunto(s)
Epífisis Desprendida/cirugía , Cabeza Femoral/cirugía , Articulación de la Cadera/cirugía , Osteotomía/métodos , Adolescente , Adulto , Niño , Epífisis Desprendida/diagnóstico por imagen , Femenino , Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/prevención & control , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/prevención & control , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/prevención & control , Radiografía
15.
Arch Orthop Trauma Surg ; 121(8): 458-61, 2001 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-11550832

RESUMEN

Symptoms of osteoid osteoma are cured by removing the nidus. 'En-bloc' resection is often not successful because the nidus is hard to find and remove totally. Recently, minimally invasive procedures have been advocated for the resection of osteoid osteoma. Preceding investigators have used a set of special instruments. The nidus is best localized with computed tomography (CT). Surgery under CT control is only possible with minimal invasive procedures. A technique using standard equipment usually available in the operating room can be used successfully for CT-guided removal of the nidus. We report our preliminary results with 17 patients (12 men, 5 women) with an average age of 22 years (range 6-57 years). All patients were pain-free immediately after the operation. The average follow-up was 8.4 months (range 1-22 months) and the average operating time 75 min (range 50-130 min). Ten patients could be treated as outpatients. The average time in hospital after surgery was 1.5 days (range 1-3 days). There were two complications, one superficial wound infection and one change of operative technique to an open procedure due to a technical problem. The diagnosis could be confirmed histologically.


Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Osteoma Osteoide/diagnóstico por imagen , Osteoma Osteoide/cirugía , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cintigrafía , Tomografía Computarizada por Rayos X
16.
J Bone Joint Surg Br ; 83(4): 547-50, 2001 May.
Artículo en Inglés | MEDLINE | ID: mdl-11380129

RESUMEN

Two consecutive cases of chronic dislocation of the head of the radius after missed Bado type-I Monteggia lesions are presented. Reduction was successfully achieved in both patients after ulnar corticotomy, gradual lengthening and angulation of the ulna using an external fixator. Open reduction or reconstruction of the radio-ulnar capitellar joint was not undertaken. The age at injury was seven years in the older and two years in the younger patient. The time from injury to treatment was five years in the older and three months in the younger child. At follow-up, nine years after completion of treatment in the older and eight months in the younger patient, both show satisfactory movement, function of the forearm and reduction of the head of the radius. This technique may be considered in missed Monteggia lesions before open procedures on the radio-ulnar capitellar joint are undertaken.


Asunto(s)
Alargamiento Óseo/métodos , Fractura de Monteggia/terapia , Niño , Preescolar , Errores Diagnósticos , Femenino , Humanos , Fractura de Monteggia/diagnóstico , Factores de Tiempo , Fracturas del Cúbito/cirugía
17.
Orthopade ; 30(4): 214-7, 2001 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-11357441

RESUMEN

Conservative treatment of clubfoot deformities with braces and bandages is traditionally several hundred years old. The clubfoot braces of Venel, Scarpa, and Schulthess, as well as the redressing bandage of Cheselden, are reviewed as typical examples. The treatment of clubfoot deformities was initiated in the Balgrist Hospital for Orthopedic Surgery by W. Schulthess. Recently, in Balgrist, we developed a brace that retains and redresses the foot. This brace is described, and early clinical results are reported.


Asunto(s)
Vendajes , Tirantes , Pie Equinovaro/rehabilitación , Fenómenos Biomecánicos , Diseño de Equipo , Humanos
18.
J Clin Oncol ; 19(6): 1818-29, 2001 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-11251014

RESUMEN

PURPOSE: Cooperative Ewing's Sarcoma Study (CESS) 86 aimed at improving event-free survival (EFS) in patients with high-risk localized Ewing tumor of bone. PATIENTS AND METHODS: We analyzed 301 patients recruited from January 1986 to July 1991 (60% male; median age 15 years). Tumors of volume >100 mL and/or at central-axis sites qualified patients for "high risk" (HR, n = 241), and small extremity lesions for "standard risk" (SR, n = 52). Standard-risk patients received 12 courses of vincristine, cyclophosphamide, and doxorubicin alternating with actinomycin D (VACA); HR patients received ifosfamide instead of cyclophosphamide (VAIA). Tumor sites were pelvis (27%), other central axis (28%), femur (19%), or other extremity (26%). The initial tumor volume was <100 mL in 33% of cases and > or =100 mL in 67%. Local therapy was surgery (23%), surgery plus radiotherapy (49%), or radiotherapy alone (28%). Event-free survival rates were estimated by Kaplan-Meier analyses, comparisons were done by log-rank test, and risk factors were analyzed by Cox models. RESULTS: On May 1, 1999 (median time under study, 133 months), the 10-year EFS was 0.52. Event-free survival did not differ between SR-VACA (0.52) and HR-VAIA (0.51, P =.92). Tumor volume of >200 mL (EFS, 0.36 v 0.63 for smaller tumors; P =.0001) and poor histologic response (EFS, 0.38 v 0.64 for good responders; P =.0007) had negative impacts on EFS. In multivariate analyses, small tumor volumes of <200 mL, good histologic response, and VAIA chemotherapy augured for fair outcome. Six of 301 patients (2%) died under treatment, and four patients (1.3%) developed second malignancies. CONCLUSION: Fifty-two percent of CESS 86 patients survived after risk-adapted therapy. High-risk patients seem to have benefited from intensified treatment that incorporated ifosfamide.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Sarcoma de Ewing/tratamiento farmacológico , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias Óseas/radioterapia , Neoplasias Óseas/cirugía , Quimioterapia Adyuvante , Niño , Preescolar , Ciclofosfamida/administración & dosificación , Dactinomicina/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Humanos , Ifosfamida/administración & dosificación , Lactante , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Radioterapia Adyuvante , Factores de Riesgo , Sarcoma de Ewing/radioterapia , Sarcoma de Ewing/cirugía , Análisis de Supervivencia , Resultado del Tratamiento , Vincristina/administración & dosificación
19.
Arch Orthop Trauma Surg ; 120(5-6): 349-51, 2000.
Artículo en Inglés | MEDLINE | ID: mdl-10853912

RESUMEN

Glenoid dysplasia is a rare abnormality of the shoulder. We report glenoid dysplasia in two consecutive generations: a boy and his father. Both suffered recurrent shoulder dislocations, and radiological examination revealed bilateral glenoid dysplasia. Our cases confirm dominant inheritance of this osseous malformation.


Asunto(s)
Enfermedades del Desarrollo Óseo/genética , Luxación del Hombro/genética , Articulación del Hombro/anomalías , Adolescente , Adulto , Enfermedades del Desarrollo Óseo/diagnóstico , Niño , Enfermedad Crónica , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia , Luxación del Hombro/diagnóstico , Articulación del Hombro/patología
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