We have studied the medium-and long-term effects of femoral intramedullary nailing in 34 children. There was a high incidence of abnormality at the proximal end of the femur, including coxa valga, arrest of growth of the greater trochanter and thinning of the neck of the femur, because of damage to the trochanterocervical growth plate. These disorders affected 30% of the patients, mostly under the age of 13 years (p < 0.05), and were seen more frequently when the nail had been introduced through the piriform fossa. Other factors, such as the side, gender, aetiology, proximal or retrograde insertion, the size of nail and removal of the implant did not influence the result. We recommend that in patients under the age of 13 years other methods of management should be used to avoid damage to the growth plate.
The cases of 35 patients in whom a triplane fracture had been treated at the Ramón y Cajal Hospital were reviewed. The diagnosis of biplane and triplane fracture can now be made by standard radiograph. However, plain radiographs alone did not accurately demonstrate the configuration of the fracture, and computed tomography must be performed. Closed reduction should be attempted first. Failure to obtain or maintain (or both) an adequate closed reduction is an indication for operative treatment. Prognosis is surprisingly good. Only when adequate reduction (< 2 mm displacement) has not been achieved can degenerative changes be seen at long-term follow-up (> 5 years).
ImportanceEvidence of implementation of laparoscopic gastrectomy for locally advanced gastric cancer is currently insufficient, as the primary end point in previous prospective studies was evaluated at a median follow-up time of 3 years. More robust evidence is necessary to verify noninferiority of laparoscopic gastrectomy.ObjectiveTo compare 5-year survival outcomes between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) with D2 lymph node dissection for locally advanced gastric cancer.Design, Setting, and ParticipantsThis was a multicenter, open-label, noninferiority, prospective randomized clinical trial. Between November 26, 2009, and July 29, 2016, eligible patients with histologically proven gastric carcinoma from 37 institutes in Japan were enrolled. Two interim analyses and final analysis were performed in October 2014, May 2018, and November 2021, respectively.InterventionsPatients were randomly assigned (1:1) to either the ODG or LADG group. The procedures were performed exclusively by qualified surgeons.Main Outcomes and MeasuresThe primary end point was 5-year relapse-free survival, and the noninferiority margin for the hazard ratio (HR) was set at 1.31. The secondary end points were 5-year overall survival and safety.ResultsA total of 502 patients were included in the full-analysis set: 254 (50.6%) in the ODG group and 248 (49.4%) in the LADG group. Patients in the ODG group had a median (IQR) age of 67 (33-80) years and included 168 males (66.1%). Patients in the LADG group had a median (IQR) age of 64 (34-80) years and included 169 males (68.1%). No significant differences were observed in severe postoperative complications between the 2 groups in the safety analysis (ODG, 4.7% [11 of 233] vs LADG, 3.5% [8 of 227]; P = .64). The median (IQR) follow-up for all patients after randomization was 67.9 (60.3-92.0) months. The 5-year relapse-free survival was 73.9% (95% CI, 68.7%-79.5%) and 75.7% (95% CI, 70.5%-81.2%) for the ODG and LADG groups, respectively, and the HR was 0.96 (90% CI, 0.72-1.26; noninferiority 1-sided P = .03). Further, no significant difference was observed in overall survival time between the 2 groups, and the HR was 0.83 (95% CI, 0.57-1.21; P = .34). The pattern of recurrence was similar between the 2 groups.Conclusions and RelevanceResults of this study show that on the basis of 5-year follow-up data, LADG with D2 lymph node dissection for locally advanced gastric cancer, when performed by qualified surgeons, was proved noninferior to ODG. This laparoscopic approach could become a standard treatment for locally advanced gastric cancer.Trial RegistrationUMIN Clinical Trial Registry: UMIN000003420
Synovial osteochondromatosis is a rare, benign condition characterised by synovial metaplasia and the formation of cartilaginous and osteocartilaginous bodies in the capsule. We report one such case in a 30-year-old woman with synovial osteochondromatosis of the hip and progressive osteoarthritis caused by femoroacetabular impingement with joint-space narrowing. She underwent surgical removal of 32 loose bodies and osteochondroplasty. A coronal osteophyte at the junction of the femoral head and neck was also excised. At 2-year follow-up, her Harris Hip Score had improved from 62 to 90.
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