Treatment of benign lesions of humerus with resection and non-vascularised, autologous fibular graft.

The aim of this study was to analyse the long-term results of surgical en bloc resection and replacement with non-vascularised, autologous fibular graft for the treatment of large benign humeral lesions without fixation. We retrospectively reviewed data of seven females and 13 males with unilateral benign lesions where steroid injection, curettage and bone grafting or pathological fracture failed to restore integrity. Subperiosteal, en bloc resection of the cystic lesion with a margin of the normal bone was performed. The average age of the patients at the time of operation was 11.8 years (range 4-28 years). All patients were skeletally mature at last follow-up. Aneurysmal bone cysts were histologically identified in seven cases, solitary cysts in 11 and fibrous dysplasia in two cases. No recurrence of the pathology, pain, graft fracture or limitation in range of motion was noted. In three patients in whom the cyst was adjacent to the proximal growth plate of the humerus, there was shortening of the bone at the last follow-up examination measuring 2 cm, 4.5 cm and 6 cm, respectively. Two cases had a valgus deformity of 10° and 15°, respectively, which was evident radiographically at the time of last follow-up. The results of en bloc resection with non-vascularised, autologous fibular graft for the treatment of large benign humeral lesions without fixation are encouraging. The risk of associated complications is low. In our opinion this should be the method of choice in the treatment of large, multi-chamber benign bone lesions of the humerus which fail more "conservative" treatment.

Evaluation of adductor myotomy versus adductor transfer to ischiadic tuber in the treatment of spastic hip in cerebral palsy.

BACKGROUND: The muscle imbalance associated with the spastic type of infantile cerebral palsy may result in subluxations or dislocations of the hip. The aim of the study was to compare the clinical and radiological results of myotomy of the hip adductor muscles versus adductor transfer to the ischiadic tuber in the prevention of hip subluxation and dislocation in infantile cerebral palsy. MATERIAL AND METHODS: The study involved 36 ambulant children with spastic diparetic CP treated at our Department in the years 1987-2002. Group I consisted of 21 children (41 hip joints) who underwent myotomy of the adductor longus, adductor brevis and gracilis muscles. Mean age at the time of surgery was 10 years (3 to 17 years). Group II consisted of 15 children (28 hip joints) who underwent transfer of the tendons of the adductor muscles to the ischiadic tuber. Mean age at the time of surgery in this group was 8 years (3 to 16 years). The mean duration of hospital stay was 6 days in Group I and 9 days in Group II. Rehabilitation was carried out for an average of 3 months in Group I and 4 months in Group II. RESULTS: The follow-up examination showed improvement in the hip range of motion in both groups and no radiographic differences. CONCLUSIONS: Adductor myotomy is superior to adductor transfer because of easier surgical technique, shorter duration of hospital stay and no need to immobilize the hip.

[Hip revision arthroplasty in massive bone loss of acetabulum with the use of reinforcement ring]. / Zabiegi rewizyjne w duzych ubytkach panewki z zastosowaniem koszy wzmacniajacych.

The aim of the study was the assessment of results after acetabular revision arthtoplasty with the use of reinforcement ring ReconShell (BBrown - Aesculap) and homogenous bone grafts. There were 49 patients in the study (42 women and 7 men) in the age from 30 to 88 years. The follow-up period ranged from 4 to 48 months. Before operation the mean Harris hip score was 31.14 and at last follow-up 71.64 points. Aseptic loosening of reconstruction ring was found in 3 patients. During next revision good integration of bone grafts, that were implanted into acetabulum at previous operation was found. In one hip revision of loose polietylen cup was performed. Three patient had early dislocation of hip endoprothesis, that were treated successfully in abduction casts. Next 2 patients had re-revision performed for recurrent dislocations. One patient had implants removal for septic loosening. Prolonged wound healing was noticed in 5 patients. Two patients had temporary and one permanent common peroneal nerve palsy. Two patients had temporary femoral nerve palsy. The use of reconstruction rings in massive bone loss of the acetabulum after cup loosening gives satisfactory clinical results. After the procedure patients have stabile joint that allows for weight bearing. Despite relatively high number of complications (most of which are temporary) this procedure is worth recommending.

[Results evaluation of children flexible flatfoot operative treatment according to Mittelmeier method]. / Ocena wyników operacyjnej korekcji stopy plasko-koslawej metoda Mittelmeiera.

The aim of the study is to evaluate results of the operative treatment of children flexible flatfoot. The investigative material consisted of 16 children (7 girls, 9 boys) treated between 1995-2004. The age at the time of operation was 9-15 years (mean 11.5 year). The average follow up period was 4.5 year (from 1 to 10 years). Clinical examination consisted of physical and subjective examination performed before and after operation. Subjective examination was performed on the basis of questinnaire. Physical examination was completed with hindfoot valgus angle measurement and with podoscopy (Clark's angle and Godunow-Sztriter index measurement). We decided to do surgery in children when conservative treatment failed. Operation was performed according to Mittelmeier method. After surgery we applied short leg cast with 10 degrees foot supination for 4 weeks. We allowed patients to walk without weight bearing by using elbow crutches for 8 weeks, and recommended rehabilitation 2-6 weeks after cast removing. According to static foot parameter we obtained 4 very good, 8 good and 4 sufficient results. According to patients subjective evaluation we obtained 5 very good, 8 good and 3 sufficient results. In two cases we had postoperative complications (prolonged wound healing). On the basis of presented material we can state that surgery according to Mittelmeier method at children above 9 years old could be benefit and should be take into consideration in treatment flexible flatfoot.