Resection of the radial capitellum. Long-term results.

The results of 39 resections of the radial capitellum reviewed after an average of 12 years were excellent or good in 59% of the cases and fair or poor in 41%. The results were better in isolated fractures of the capitellum (excellent or good, 71%) compared with those with associated lesions in the same limb (excellent or good, 44%). A reduction of movement was frequently observed, particularly in pronation and supination, which was limited in 28% of the cases and abolished in 15%. In 4 patients there was a significant increase in cubitus valgus. Arthrosis was present in 45% and periarticular calcification in 74% of the cases. There were 5 cases of radioulnar synostosis and 4 cases of myositis ossificans. Subluxation of the distal radioulnar joint was observed in 26 wrists, 4 of which were painful. The results of resection of isolated fractures may be considered acceptable, while the prognosis of fractures with associated lesions is more unfavourable.

[Surgical treatment of fractures of the neck of the radius in children and adolescents. Review of 24 cases]. / Il trattamento cruento delle fratture del collo del radio nel bambino e nell'adolescente. Revisione di 24 casi.

At the Orthopaedic Clinic of the University of Perugia from 1973 to 1984, 28 fractures of the neck of the radius were treated with open reduction in children aged between 4 and 15. Follow-up evaluation showed a high percentage of poor results (33.3%) frequently associated with a deficit of pronation and supination. Clinical results were related both to the severity of the displacement and to the radiographic results at follow-up. Open reduction is essential in highly displaced fractures, but it can be avoided in those with minor displacement.

Rapidly progressive osteoarthritis of the hip.

Osteoarthritis of the hip is rapidly progressive in 5% of cases, particularly in patients of advanced age. At times there is total destruction of the femoral head. Nineteen such cases are described and the literature is reviewed. The clinical picture is dominated by rapidly progressive pain and limping; the radiographic picture by the absence of osteophytosis. The pathology of rapid progression is subdivided into primary and secondary. Several hypotheses of the pathogenesis are discussed. These are related to mechanical overloading factors, local cortisone therapy, anoxia, synovitis. Differential diagnosis is with subacute septic arthritis, monarticular rheumatoid arthritis, and idiopathic osteonecrosis of the femoral head. Prosthetic replacement is the only treatment indicated and the long-term results do not differ from those obtained in prosthetic replacement for the more common type of osteoarthritis.