I believe that surgery offers a chance to rehabilitate these seriously ill patients in a shorter time than any other method. Spontaneous fusion requires, on an average, over six years.
The mortality in this disease is high,-26.6 per cent. in the 203 consecutive patients in this series.
With adequate surgery, a high percentage of excellent results and a low mortality may be expected in patients in Groups A and B.
Patients with positive sputum in Group C present a definite risk. Every effort should be made to control the pulmonary disease before surgery may be reasonably attempted.
Patients in Group D, who have declared their group by definite evidence of metastatic spread, have a mortality of almost 70 per cent., and no surgical treatment other than emergency measures to relieve pain should be attempted.
In this series, 62 per cent. of our patients were in the more favorable Groups A and B. The 38 per cent. in Groups C and D were carefully selected for surgery. This should be borne in mind, as any indiscriminate selection of patients for surgery from these less favorable groups will result in an appalling mortality.
(C) 1940 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.