Two series of 20 patients each with unicameral bone cysts were compared, one treated before 1975 by curettage and bone grafting and the other treated after 1975 with methylprednisolone acetate (MPA) injections. At follow-up, the majority of patients were at the end of skeletal growth. In the MPA-treated series, the average age of the patients at diagnosis was 9.1 years, whereas the average age at follow-up was 16.7 years. The average follow-up interval was 7 years. The steroid-treated series had better radiographic final results than the surgically treated series, with a lower recurrence rate. The number of MPA injections required to heal the lesion ranged from one to six, with 70% of the patients requiring a maximum of three injections. Steroid injection treatment should be preferred to surgical treatment for the better final results, for the virtual absence of complications, and for the greater simplicity of execution and postoperative care.
Anatomical reduction and stabilization of displaced supracondylar humeral fractures in children is necessary to obtain good results. For most cases percutaneous crossed pinning is recommended. Sometimes open reduction is necessary but even in these cases neurological complications and varus deformities have been reported. So the technique of open pinning was modified. From 1995 to 1998 22 children were treated by a dorsolateral approach. The fracture was stabilized by crossed pinning: The proximal K-wire is drilled 10 degrees ascending to the dorsal humerus through the medial pillar into the ventral part of the medial epicondyle, after shortening it is not bent. The distal K-wire stabilizes the lateral pillar, after shortening its end is bent down. Immobilization for 3-4 weeks, mobilization is done by the patient. The implants are removed 2 weeks later. The follow up in 21 out of 22 patients (8-57 months, mean 35 months) according to Flynn's criteria showed 16 excellent, 4 good and 1 fair result. The fair result was due to valgus deformity. One patient has been reoperated due to displacement of K-wire. Neither iatrogenic nerve lesions nor varus deformities nor infections did occur. The dorsolateral approach combined with the above mentioned technique of pinning shows excellent and good results.
The tendon sheaths of extensor pollicis brevis (EPB) and abductor pollicis longus (APL), obtained from four patients with de Quervain's disease were studied by light and electron microscopy. Three different layers were identified in the sheath which was much thicker than normal. Both the outer and the middle layers had thick bundles of collagen fibres with scattered fibroblasts. The inner layer was mainly formed by chondroid and myxomatous tissue. Collagen fibrils were thicker than normal, reaching 2100 nm in diameter. Numerous cells which resembled "myofibroblasts" were scattered throughout the whole thickness of the sheath. The results seem to indicate that thickening and hardening of the EPB and APL tendon sheaths in de Quervain's disease is caused by increased synthesis of the extracellular matrix, increased thickness of the collagen fibrils and areas of myxomatous and chondroid metaplasia.
Intraosseous av anastomoses with acidosis and hypoxia of the tissues are probably responsible for the excessive activity of osteoclasts in acute posttraumatic dystrophy. Even enhancements in the late static phase of the three phase bone scan (TPBS) are in agreement with this hypothesis. In cancellous bone these enhancements are induced by the bone seeking tracers. The nomenclature for these tracer molecules is in line with the recommendations of International Union of Pure and Applied Chemistry (IUPAC) as methylene bisphosphonate and hydroxymethylene bisphosphonate. From this, therapeutic recommendations for posttraumatic dystrophy can be derived. The term diphosphonates should be changed to bisphosphonates.
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