A long-term follow-up (3.5 years mean) of 106 operated ankle fractures out of 167 patients revealed 73.7% excellent and good, 16% acceptable and 10.3% poor results. Anatomically exact reduction was shown to be a prerequisite for good results and was seen in 77.2% of all cases. By neglecting biomechanical principles an insufficient reconstruction led to a poor final outcome. But even in 11% of the excellent operatively treated fractures late arthrosis developed. Statistical analysis showed that the onset of posttraumatic arthrosis was correlated with and predicted best by the number of single lesions. Dorsiflexion testing was the clinical parameter correlating best with the extent of the injury, the degree of arthrosis and the subjective complaints. This underlines the importance of assessment of dorsiflexion as a clinical screening test for remaining sequelae after ankle fractures.

The solitary bone cyst is most frequently located in the upper arm and the average age of the affected patients is between 7 and 9 years, thus perceptibly lower than in cases where solitary bone cyst occurs elsewhere, where the average age is 15. The tendency towards recurrence before 10 years of age is twice as great as the tendency after that age. Investigation of the results obtained from the treatment of 26 patients suffering from solitary bone cyst of the humerus showed a recurrence rate of 55% after curettage and filling-in of the defect with cancellous bone grafts, whereas after total subperiosteal resection and bridging the defect with an autologous tibia graft the corresponding recurrence frequency was 7%. The average duration of the plaster cast fixing period after resection treatment was 18 days longer than after curettage, but the low rate of recurrence in the first-mentioned case makes up for this disadvantage. It is absolutely essential to retain the periosteum in cases of cyst resections. The defect is bridged over by an autologous tibia graft, but fibula grafts are also suitable for bridging the defect. Osteosyntheses are not necessary with latent cysts. In the case of active cysts screws, wire loops, Kirschner wires, and thin Küntscher nails can be used as temporary stabilisation means. Plate osteosyntheses constitute an exception. Complete removal of the cyst by resection is the most certain prophylactic method against recurrence, and hence the most reliable form of treatment of the solitary bone cyst of the humerus.

No abstract

The simple bone cyst (sbc) is generally regarded as a tumourous bone lesion, to be classified with the bone tumours. It is a non-malignant disease which, however, affects adolescents in the immediate area of the epiphysis, so that disturbances of growth and deformities cannot always be avoided. The commonest localisation is stated to be at the proximal humerus, followed by the femur. The authors shell out small sbc, filling the defect with autologous spongiosa, but treat recurrences and extensive cyst formation by means of limb-preserving resection. Procedure followed, e.g. at the humerus; resection of the tumour en bloc, formation of a groove in the head of the humerus, into which an autologous tibia graft is driven, after this has been fitted into the distal humerus after Lexer, where the transplant is fixed by 2 AO screws, or by boring the graft into the marrow canal of the distal humerus, without using extraneous material for osteosynthesis. Postoperative stabilisation is effected in a thoracic abduction plaster for an average of about 12 weeks. A review of the results of treatment in 26 patients with sbc of the humerus showed a recurrence rate of 55% after curettage and filling with spongiosa, against 7% following resection. Complete removal of the cyst by resection can thus be taken to be the most reliable prophylaxis against recurrence in the upper arm. In certain cases, we also perform a subtotal resection of the proximal femur. Of these patients, 22 were followed up:(ABSTRACT TRUNCATED AT 250 WORDS)