Locking graft in the treatment of tibial pseudarthrosis.

Despite modern treatments of tibial fractures, we still have nonunions. In case of failure we used a method of treatment which has become less popular over the last decades. A rectangular inlay graft is harvested from the anteromedial tibial surface. The graft, measuring about 12 to 15 cm long, is placed over the nonunion with 2/3 of its length on one side and the remaining third on the other side. The graft is turned 180 degrees and fixed with four lag screws in the original donor site. Postoperatively, we place a nonweight-bearing cast for 3 months. The results are quite satisfactory for both nonunions and difficult multi-operated nonunions.

Internal fixation of tibial plateau fractures using the AO instrumentation.

Between January 1970 and December 1985, 76 patients (76 fractures) underwent internal fixation for tibial-plateau fractures as recommended by the AO-group (14). Fifty patients were available for follow-up. The long term results of this retrospective study are reported. Subjective results were satisfying. Forty-four percent of the patients were painfree and only 8% had severe postoperative pain, which was clearly related to osteoarthritis. Eight-eight percent of patients had no instability at follow-up. Clinical and radiographic results were evaluated for mobility, laxity and osteoarthritis. Thirty-five patients had a loss of flexion averaging 16.6 degrees. In 12 patients the average decrease in extension amounted to 7.5 degrees. Valgus increase averaged 9.7 degrees in 17 patients, and the average varus increase was 7.5 degrees in 4 patients. Seventy-four percent of patients showed no laxity at follow-up. The finding of osteoarthritis on X-ray was well correlated with the postoperative incongruence of the articular surface. It was also found to develop earlier in patients who underwent (partial) meniscectomy. Some general considerations about tibial condyles fractures are presented, and the technique used by the authors is discussed at length. The indications for internal fixation are also evaluated. The importance of adequate reduction, stable internal fixation and vigorous postoperative rehabilitation is stressed.

[Long-term results of the Krogius-Roux operation]. / Les résultats à longue échéance de l'opération Krogius-Roux.

The authors have reviewed patients treated with the operation of Krogius-Roux with a long follow-up, especially on the indication of recurrent dislocation of the patella. Thirty-nine patients out of 76 operations have been evaluated.

Acetabular bone stock reconstruction with frozen femoral head allografts and the use of a cementless screw cup in total hip revision surgery. A 5 years' clinical, radiologic and scintigraphic follow-up.

This prospective study reviews the behaviour of a cementless conical screw cup in total hip revision surgery with or without the use of bone grafts to reconstruct acetabular bone stock. Clinical and radiologic results are given. For proper radiographic interpretation a new classification system is suggested, based on histologic features, the principles of which are explained. The results of auto- or allografts for the treatment of the same pathological condition are compared. The difference between both grafts successively in bone incorporation, biochemical behaviour, morbidity and mortality rate is discussed. The difference between a cancellous and a cortical bone transplant in the mechanism of repair is discussed. This study also analyzes acetabular bone graft activity using serial technetium-99m bone scans. Some guidelines for rehabilitation programs can be deduced from these observations. Finally, a correlation between graft incorporation and the acetabular deficiency to be reconstructed can be postulated.

Cytological changes due to urinary calculi: a consideration of the relationship between calculi and the development of urothelial carcinoma.

Urinary calculi can induce urothelial cellular abnormalities comparable with those of malignancy; this was found in 11 out of 62 lithiasis cases. Severe cellular changes, comparable with those of carcinoma in situ, may be seen in the epithelium adjacent to a calculus. Squamous metaplasia was frequently observed in cases with staghorn stones in the renal pelvis. The abrasive effect of the calculus may result in many multinucleated cells in the sediment. When the calculi are removed the cytological atypia and the observed multinucleation disappeared, and none of these 62 patients developed urothelial carcinoma. A possible relationship was found between a long-term clinical history of lithiasis and the development of cancer of the upper urinary tract in a study of 92 cases of carcinoma of the ureter and renal pelvis.