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In immature long bones, radical excision of malignant tumours of the metaphysis may necessitate sacrifice of the adjacent epiphysis. To preserve the adjacent joint while allowing a safe margin of excision, we used physeal distraction before removing the tumour. From July 1984 to August 1992, we operated on 20 patients by this method. After a mean follow-up of 54 months there was no local recurrence in the epiphyseal region. Three patients had developed pulmonary metastases.

Using two-month-old pigs selective epiphysiodesis of the neurocentral cartilage was performed using cancellous screws inserted to achieve effective compression. The operation was performed on eight experimental animals, on the right side, involving four or five vertebrae at the mid thoracic level. The procedure consistently caused structural scoliosis, convex on the side of operation. The radiographic, macroscopic and microscopic findings in the experimental animals are described. In other animals so treated at ages when the neurocentral cartilage is not active rotational deformity did not occur.

We compared several image methods in the evaluation of the possible physeal effect in 47 osteosarcomas and 18 Ewing's sarcomas in children. The minimal follow-up was 3 years (range, 3-17). In the histological study, the physis was affected in 53% of the cases. We correlated the histological findings and the findings from the different image methods. There were more false-positive than false-negative results, and in the computed tomography and magnetic resonance imaging (MRI) studies, there were no false negatives. The accuracy of MRI (predictive positive value plus predictive negative value) was the best (90.3%), and it is the technique that we prefer. According to these findings, we can safely preserve the epiphysis in cases of metaphyseal tumors showing no contact between the tumor and the growth plate in the MRI images. If the tumor shows contact with part of the physis, it is also possible to preserve the epiphysis.

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SUMMARYWe present a long term evaluation of 100 high valgus tibial osteotomies with a mean follow up of 11 years. Knees with slight or moderate osteoarthritis had the best results. Slight overcorrection was beneficial, but gross overcorrection was not. There were few complications and the overall long term results were good. RÉSUMÉNous présentons une évaluation à long terme de cent ostéotomies de valgisation de l'extrémité supérieure du tibia, avec un recul moyen de 11 ans. Ce sont les genoux atteints d'arthrose minime ou modérée qui ont eu les meilleurs résultats. Les hypercorrections légères ont été bénéfiques mais non les hypercorrections excessives. Il n'y a eu que peu de complications et dans l'ensemble les résultats à long terme ont été bons.

SummaryClinical and laboratory variables were measured on the day before operation in 111 patients who underwent total hip replacement prophylactically treated with acetylsalicilic acid or heparin-dihydroergotamine. Postoperative deep vein thrombosis (DVT) was deteced in 16 patients by ascending venography. Stepwise logistic discriminant analysis was used to identify DVT predicting factors. Three such factors, fibrinogen degradation products (FDP), plasminogen activator inhibitor (PA-inhibitor) and tissue type plasminogen activator (t-PA), were found to be significantly associated with DVT and were used to construct a predictive index. The predictive index, I = —2.09 + 0.46 (FDP) +1.39 (PA-inhibitor)-0.24 (t-PA), was 100% sensitive and 95% specific in the prediction of DVT. This index would allow for identification of those patients in whom routine prophylaxis would be sufficient and for selecting those in whom more effective prophylactic regimens would be necessary.