At 6 week review, the patient complained of increasing pain, inability to fully weight bear and a decreased range of movement. 35 fixed flexion deformity, 30 degrees external rotation and 20 degrees of valgus of the leg. Radiographs revealed a transverse supracondylar fracture extending through the level of the pin fixation. Subsequent surgery involved an osteotomy to correct the deformity and application of a lateral femoral plate After fixation direct inspection of the retained anterior cruciate ligament, revealed and intact graft that functioned through the full range of movement. At nine months, the patient is fully weight bearing has returned to her pre-injury sporting level and has a range of movement of 0–110 degrees. There was no objective knee instability and the patient is satisfied with the outcome. Femoral fractures have rarely been reported in the literature following ACL reconstruction and these are usually associated with drilling of an enlarged femoral tunnel. We report a rare case of a transverse supracondylar femoral fracture following ACL reconstruction, with the fracture occurring through the fixation tract not the femoral tunnel.
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.
We discuss the management and outcome of 52 patients who presented with malignant tumours of the fibula over a 15-year period between1983 and 1998. The tumour type was Osteosarcoma (23 patients), Ewing’s sarcoma (16), Chondrosarcoma (11 – of which 10 low grade) and Malignant Fibrous Histiocytoma (2). We concentrate on the two most common frankly malignant groups: Osteosarcoma and Ewing’s. The male:female ratio of patients with Osteosarcoma was 11:12 and with Ewing’s Sarcoma was 11:5. Mean age for Osteosarcoma was 21. 5 years and for Ewing’s Sarcoma was 14. 2. The most common site of tumour was in the proximal fibula in both Osteosarcoma (19 / 23) and Ewing’s Sarcoma (10 / 16). The stage of disease at presentation was IIa or IIb in the majority of patients, with seven patients presenting with metastases. The current investigative procedures are Radiographs, Magnetic Resonance Imaging, Radioisotope Bone Scans, Computerised Tomography of the chest and needle biopsy whereas in the past CT of the lesion and open biopsy were common. Chemotherapy was administered as per protocol at the time of diagnosis and radiotherapy was given in selected cases. Surgery was performed on all but 3 patients, who were unfit and died. This consisted of local en bloc resection in 86. 3% and above knee amputation in 6. 8%. Whereas all the diaphyseal and distal lesions were completely excised, 9 out of 26 proximal lesions had a marginal excision, 4 of which had open biopsies. The common peroneal nerve was sacrificed in 50% of cases and this had no link to survival. The overall 5-year survival was 33% for Osteosarcoma and 40% for Ewing’s Sarcoma, with proximal lesions doing much worse than diaphyseal and distal lesions. Patients who had marginal excisions all died within 2. 5 years.
