Traditionally midshaft clavicle fractures have been treated conservatively. It is recognized that displaced and shortened fractures may be better treated operatively. In particular, patients with greater than 20 mm of shortening and 100 percent displacement have a symptomatic non union rate of 30 percent. The standard technique used previously has been via plate fixation with LC-DCP or DCP. However in the last 5 years intramedullary fixation has been popularized. “Rockwood intramedulary clavicular pin” remedies the past treatment issues including poor blood supply, painful prominent hardware and stress raiser related to removal of metal work.
This preliminary report demonstrates the effective use of Apapore in the management of benign cystic bone lesions. The use and development of bone graft substitutes over the past ten years has increased dramatically to improve their osseo-integration to a level similar to autografting techniques without the drawbacks of comorbidity from the graft site. Apapore is a synthetic bone graft substitute which consists of a scaffold of synthetic phase-pure hydroxy apatite with micro- and macroporosity and inter-connectivity to favour bone repair. Nineteen patients (12M:7F) with a mean age of 18.6years (8–33 years) having had procedures for the management of benign cystic lesions of bone with grafting using Apapore were followed up retrospectively for a mean period of 8 months (1–16months). In each case the diagnosis of a benign cystic lesion was made histologically prior to surgery. The subsequent definitive procedure was performed by a consultant on the Bone Tumour Unit at the Royal National Orthopaedic Hospital (Stanmore) in each case involving curettage and impaction of Apapore into the cavity in a standard fashion as a general anaesthetic procedure in the operating theatre. There have been no complications to date. All patients have made uneventful recoveries. Short-term radiological follow-up demonstrates excellent incorporation of the bone graft substitute and osseo-integration.
When managing malignant bone tumours in the distal femur with limb salvage, resection and reconstruction with a distal femoral replacement (DFR) conventionally entails prosthetic replacement of the knee joint. In younger patients it is desirable to try to preserve the knee joint. We now use a new Joint-Sparing distal femoral prosthesis in those cases where it is possible to resect the tumour and preserve the femoral condyles. Purpose of study: To look at our early results with knee joint preserving DFR’s. Methods: Between June 2001 and March 2004 the prosthesis was implanted in 8 patients (5 males and 3 females) aged between 8 and 24 years at the time of surgery. The diagnosis was osteosarcoma in 6 cases and chondrosarcoma in 2 cases. All patients were followed regularly and knee range of movement was recorded as well as any complications that occurred. Patients were functionally evaluated using the MSTS Scoring System. Results: Six of the patients had a mean follow-up of 20 months (range 8–33) and in this group 4 had good knee flexion with a mean flexion of 122° (110–130), 1 patient had fair flexion of 60° and 1 patient had poor flexion of 20°. The mean fixed flexion deformity in the 3 patients who had such a deformity was 10° (5–15). There were no intraoperative complications but the patient with poor flexion required an arthrolysis and because of the poor result is under consideration for conversion to a conventional DFR. Two patients had follow-up periods of 3 months or less and are still in their early rehabilitation period. One patient in this group developed sepsis that resolved after an open washout. Conclusions: Our early results with this prosthesis, in the patients with adequate follow-up, have been good in the majority but the two cases of fair and poor knee flexion are disappointing. This particular problem may relate to design and technical factors, which will be discussed in detail.
Clear cell sarcoma of soft tissues is a rare, poorly understood tumour with little written about it in peer reviewed literature. The aim of this paper is to present a consecutive series of patients treated at our institution. All patients were staged using the system of the musculo-skeletal tumour society (MSTS). The aim of surgery was to achieve a wide excision. Adjuvant chemotherapy or radiotherapy was used in some patients depending on the margins, age and general health of the patient. Follow-up comprised clinical examination, magnetic resonance imaging (MRI) of the tumour bed and chest x-rays. Patients were seen 3 monthly for the first 2 years and then 6 monthly. Between 1997 and 2003 14 patients were included. There were 5 males and 9 females with a mean age of 49 years (21–82). Mean follow-up was 42 months (1–84). Seven tumours occurred in the upper limb and 7 in the lower limb. Four patients were lymph node positive at presentation. The mean maximum diameter of the tumour was 5.6 cm (2–8). Ten patients were referred prior to excision but 4 patients had already undergone inadvertent excision biopsy elsewhere. Four patients developed local recurrence and 3 patients developed metastases. Seven patients remain disease free, 2 have no active disease, 1 is alive with disease and 4 have died of the disease. The 2 year survival in this series is 71%. Poor prognostic factors include positive lymph nodes at diagnosis, maximum diameter of the tumour greater than 5cm and incomplete initial excision. It is important that these patients are treated early and that wide excision is achieved. We recommend early referral to a recognised musculo-skeletal tumour centre.
The patient was treated non-operatively. On discharge at 10 weeks he had normal sensation to L3 and grade 5-power on left knee extension and grade 4-power on the right. There was no motor recovery distal to this. He had a hypotonic neurological bladder with sufficient resting tone in the sphincter to prevent incontinence.
The classification system reflects gradually increasing biological stability of the construct.
Part of the clinical work up had included an isotope bone scan, which revealed a focal area of increased uptake in the L1 vertebra. On MRI, the vertebral lesion had a ‘halo’ of high intensity signal with infraction of the upper vertebral endplate. There were no clinical symptoms arising from the vertebral lesion. The differential diagnosis of the L1 lesion suggested was either a meta-static Ewing’s tumour or an aggressive haemangioma. Given the possibility of a multifocal or metastatic lesion, a vertebrectomy and reconstruction with femoral allograft was performed. A second stage posterior stabilisation from T12 to L2 was performed. Histological examination of the resected vertebra revealed a benign capillary haemangioma. On recent review one year after treatment, the patient remains in remission from his tumour and has successful graft incorporation with minimal symptoms from his spine.
INTRODUCTION: Regular review [ Spinal flexion is the commonest mechanism of injury and has been associated with scrum engagement, scrum collapse, rucking or mauling, and mistimed tackling. The second most common mechanism of cervical spinal injury is hyper-extension. This commonly occurs during tackling, particularly the ‘gang tackle’ involving several participants simultaneously, where sudden deceleration of a player’s head may lead to cervical hyperextension, focal spinal stenosis and potential damage to the spinal cord by a “pincer” mechanism. The most commonly reported levels of injury are C5/6 and C4/5 [ METHODS: A retrospective review of neck injuries presenting to a major spinal injuries facility and resulting from all codes of football (rugby union, rugby league, soccer, indoor soccer and touch) was conducted and 38 cases identified. RESULTS: Of the 38 patients, 14 were injured playing rugby union, 15 rugby league, three soccer, one indoor soccer, one touch football and four were playing an unidentified code. Six players were injured while scrummaging, five rugby union and one rugby league. 21 people were injured as tacklees, four as tacklers and two with unspecified involvement in a tackle. One person was injured whilst “heading” the ball, and three people were injured in a non-contact or unspecified action. At final follow-up, four people were found to be quadriplegic (ASIA A), 10 quadriparetic (ASIA B – 0 C –1 and D –9) and 24 recovered completely (ASIA E).
We aim to present an 18 Month Review of one Surgeons Practice Involving 16 Patients with 3 or 4 part Fractures or 3 part Fracture-Dislocations of the Proximal Humerus in patients under 60 years of age. Management principles include anatomic reduction, internal fixation and early movement. The implants used in this series include: The PLANTAN PLATE from ATLANTECH The STRATEC 4.5 mm ANGLE BLADE PLATE The POLARUS NAIL and various small cannulated screw systems. 3 patients were treared with minimal fixation, 5 with the AO Bladeplate, 4 with the PLANTAN plate and 4 with the Polarus nail. Surgical Treatment, Radiographic and Clinical Outcomes will be reviewed. Anatomic considerations, surgical technique and outcomes will be discussed.
We present our methodology and some preliminary results.