A personal experience is recounted of operations in cases of tumour involving the humerus or femur with restoration by endoprostheses. Twenty-four patients were treated in this way from 1950 to 1969 inclusive and have been followed up for between four and twenty-four years. The patients selected for treatment have presented chondrosarcoma (ten), so-called benign giant-cell tumour of bone, usually recurrent (nine), angiomatous osteolysis (two), seemingly single thyroid or renal metastasis (two), and ununited pathological fracture after irradiation of a tumour (one). Development of the prostheses from early beginnings is outlined. Some points in surgical management are referred to. The complications and results are recorded.
1. A simple cone arthrodesis of the metatarso-phalangeal joint of the big toe based on the Rose and Mann operations is described. 2. New instruments have been devised to simplify the procedure. 3. Thirty-one operations have been performed on twenty-three patients. Bony fusion has occurred in all but one case. There have been no complications.
1. Seven cases of infection following medullary nailing of the femur have been studied. 2. Points in the diagnosis of nail track infection are emphasised, especially periosteal reaction. 3. It is felt that a sinograph is an essential part of the investigation and can be useful to assess progress. 4. The principles of treatment of established nail track infection are: adequate drainage of the fracture site; dependent drainage of the whole track by draining the pocket at the lower end; the use of instillation tubes to irrigate the nail track with antibiotics. Once the fracture is stable and the nail track adequately treated by local and general antibiotics the nail should be removed. It is not considered necessary to wait for bony union before removal of the nail.
1. An oblique displacement osteotomy of the distal third of the first metatarsal is described for the correction of adolescent hallux valgus. 2. No fixation of the fragments is necessary, stability depending upon displacement in the over-corrected position for two weeks. 3. A follow-up of twenty-five operations has shown only one failure, from recurrence of the deformity. There have been no complications.
1. Fifty-nine patients with fractures of the medial epicondyle of the humerus have been reviewed, of whom more than one-third also had a dislocation of the elbow. 2. The final disability has been shown to be very slight. Non-union occurs very often with conservative treatment, but gives no disability. Union can be obtained by fixation with a Pidcock pin. 3. Operative treatment is advised only when the fragment is included in the joint. It is suggested that the best position of the elbow in patients treated conservatively is about 60 degrees below the right angle.
1. Thirty-one cases of tuberculosis of the elbow have been reviewed and the general characters of the disease described. 2. The condition is classified into four types distinguishable radiologically. 3. Treatment is predominantly conservative. Operation is sometimes indicated for extra-articular lesions. Arthrodesis is advisable in selected cases but it is not essential for healing. 4. Of twenty patients observed for five years or more, seventeen returned to work, seven required permanent splintage and five had residual pain or sinuses. 5. It is suggested that the best position for fixation of the elbow is 30 degrees below the right angle.
