Indications and possibilities of surgical therapy in osteodystrophia deformans Paget

: Among the 105 patients treated in the orthopedic department of the Balgrist university hospital in Zurich for Paget's disease of bone, a total of 353 skeletal lesions have been recorded, sited mainly in the pelvic area, in the lower extremities and in the spine. The average age of these patients at diagnosis was 64 years. In 20% of them only one bone was affected, while in 80% the condition was polyostotic. One-third of the bone changes are asymptomatic and were discovered incidentally. Deformities of the tubular bones are the most frequent pathological finding, being observed in 33% of these patients, followed by joint damage resulting from the illness in 20%. In a total of 35 patients it has been necessary to correct deformities of the tubular bones or joint malpositions because of an inherent risk of fracture, or to perform internal fixation of pathological fractures. Great importance is laid on preoperative evaluation of the pain genesis, and if it cannot be adequately determined from the history calcitonin medication is tried out. The postoperative healing tendency for bones and soft tissues is good in the vast majority of patients; there is no delay in fracture healing even with the rather long period of perioperative medication.