Breaking bony bridges by physeal distraction

Physeal distraction for breaking bony bridges and the late treatment of long bone deformities in children near maturity, has been used in our Department since June, 1983. In all cases (4 bones in 3 patients) a deformity was present at the extremity of a long bone due to a bony bridge caused by a previous injury to the growth cartilage. The results were excellent and in our opinion there are advantages over other methods. The operation itself is not extensive and very little damage is done. There is no need for internal fixation or bone grafts. It is possible to obtain lengthening and to adjust the angular correction during treatment. We conclude that it is possible to correct angular deformities and bone shortening due to bony bridges by physeal distraction without the need for resection of the bony bridge. At present we recommend this method in children near skeletal maturity, especially in those cases with bone shortening

Correction of angular deformities by physeal distraction

Physeal distraction is an alternative to more conventional treatments for the correction of angular deformities of the long bones. Twenty deformities of the femur and tibia, nine of which also involved associated shortening, were partially or completely corrected. In eight cases, there was physeal bony bridge. Complete correction of the angular deformity was achieved in 17 patients, and in seven patients, more than 80% correction was achieved. There were complications in four patients that hindered complete correction of the deformity, or shortening, or both. The external control of the correction until consolidation occurs is progressive and fairly noninvasive. The method allows external control of the correction until consolidation; it acts at the site of the deformity itself and permits lengthening and angular correction during therapy. In deformities with a physeal bony bridge, correction can be achieved with physeal distraction alone, prior resection of the bridge is not unnecessary. The technique is indicated in cases of angular deformities in patients nearing skeletal maturity and particularly in subjects in whom there is associated shortening

Experimental physeal distraction in immature sheep

An experimental study on physeal distraction was carried out in the distal femur of 45 two-month-old lambs for the purpose of identifying the basic mechanism of lengthening as well as assessing growth cartilage viability after lengthening. The animals were divided into three groups, each with three subgroups, according to the distraction rate employed (2 mm/day, 1 mm/day, 0.5 mm/day) and the time at which the animals were killed (end of lengthening, 1.5 months postlengthening, and at six months of age). Another group of three animals whose femurs were lengthened at a rate of 0.5 mm/day was killed ten days postoperatively. Roentgenologic, specimen measurements, and histologic studies were performed on all animals. The results obtained showed that the basic mechanism for lengthening is the production of a physeal fracture between degenerative and calcified layers; this finding was consistent. It was also observed that the lower the rate of distraction employed, the greater was the short- and long-term viability of the growth cartilage. More specifically, optimal viability was observed when a distraction rate of 0.5 mm/day was employed

Fractures of allografts used in limb preserving operations

One hundred and thirty-seven allografts used since 1986 in limb preserving operations for malignant bone tumours were reviewed. The follow up was longer than two years. There were fourteen fractures (10.2%) in twelve patients at a mean time of 22 months from the operation. Most of them were in the metaphyseal area and were related to perforations of the allograft made for stabilisation with plates, for tendon and ligament reattachment, or any other hole in the allograft. Fractures occurred always after the allograft-host junction was united. Healing was achieved in 7 cases by internal fixation with autologous bone grafting in a mean of 5 months. In cases of multiple fractures of the allograft, the graft was exchanged. We recommend using intramedullary fixation in order to reduce the incidence of allograft fracture, and the use of internal fixation, with intramedullary whenever possible, and autologous bone grafting to achieve consolidation of the fractures

Tratamiento del síndrome de sufrimiento del mediano en el tunel carpiano

En 3 de los 8 casos se llevó a cabo la intervención quirúrgica: la carnicera, una costurera y el lechero acromegálico (en ambos dedos). Exponemos con detalle la técnica empleada. Los resultados fueron buenos, precoces y brillantes sobre las parestesias, más tardíos y moderados, pero evidentes, sobre las atrofias

Limb Salvage for Malignant Bone Tumors in Young Children

From March 1984 to April 1991, the Orthopaedics Department of the Clínica Universitaria de Navarra treated 47 cases of malignant bone tumors in young children by limb-salvage surgery. Mean follow-up time was 4.4 years. The histologic diagnoses were osteosarcoma (33 cases) and Ewing's sarcoma (14 cases). All patients were treated following the Cancer Protocol of the Clínica Universitaria de Navarra. We used allograft reconstruction in 26 patients, autograft reconstruction in seven, and nonbiologic material in seven other patients. Thirty-six of these patients are alive currently; 11 have died. The overall survival rate was 76.6%. Three patients suffered local recurrences, and seven developed metastatic disease. The most significant complications were infection in four cases, and osteosynthesis anchorage detachment in eight cases. We believe that with recent medical, surgical, and rehabilitative advances, limb-salvage surgery has surpassed amputation as the primary treatment for malignant bone tumors in young childre

Biopsy technique in the treatment of osteosarcoma

Seventy-eight consecutive patients with stage IIB osteosarcoma of the appendicular skeleton, treated between 1982 and 1992, were studied to determine whether the technique of biopsy affected the prognosis for long term survival. The risk of local recurrence was significant (p < 0.02) after open biopsy, as was the poor response to chemotherapy (p < 0.05) after percutaneous biopsy. We recommend percutaneous biopsy, if possible, when an osteosarcoma is suspecte

Appendiix II: List of genera and species cited in this issue

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