Purpose of the study: Therapeutic options for retractile capsulitis ranges from therapeutic abstention to arthroscopic arthrolysis. The purpose of this work was to examine the efficacy of a simple therapeutic option (arthrodistention + self-mobilisation).

Material and methods: This was a prospective study of a consecutive series of 41 patients (28 female, 13 male), dominant shoulder 57%. Inclusion criteria were deficient in passive range of motion ≥ 50% compared with the other side in at least two planes, without notion of trauma or surgery. Diagnosis and inclusion: one surgeon. Arthrodistension with corticosteroid injection: one radiologist. Recommendations for self-rehabilitation, the day of the arthrodistension: one physical therapist. Patients were reviewed at 30, 90 and 180 days to analyse pain (visual analogue scale, VAS), daily life activities (Constant score), range of motion.

Results: From day 1 to 6 months –VAS regressed from 5.8 (2 – 9) to 0.8 (0/2). Constant daily activity score improved from 1/4 to 3.6/4; FA from 82 (60/115) to 170; (150/180); Re1 from 5 (−10/30) to 50 (20/70); RI from 12 (0 – 30) to 30 (10/60). Recovery was correlated with deficit in RI (p< 0.005). The greater the RI deficit the less rapid the recovery.

Discussion: We did not use the overall Constant score because of the difficulty in evaluating force. An analysis of the literature shows that therapeutic abstention can provide recovery, but with a delay of about two years. Arthroscopic arthrolysis, interscalenic blocks provide a much quicker recovery (6 months). The results obtained here are comparable with those obtained with these more complex methods./

Conclusion: This study shows that a simple management strategy enables the same results as with more invasive and more costly techniques. The patient should be warned that an important deficit in RI will undoubtedly lead to a slower recovery.

Purpose: Pluridisciplinary therapeutic management is well defined for metastatic long bones. There are few prognostic criteria enabling an evidence-based choice between palliative surgery or abstention. We report a series of 24 metastatic femurs treated by palliative surgery and evaluated with the Tokuyashi score.

Material and methods: Sixteen women and eight men, mean age 71 years (5!-89) underwent centromedullary nailing of a metastatic femur (13/16 breast cancer in women, 20.24 other metastases. The Toskuhashi score was > 6 for 16/24 patients with pain unresponsive to morphine. Thirteen patients had fractured femurs and eleven had frail femurs due to the metastasis. Mean time to surgery was six days (1–15).

Results: A solid nail was used for four patients and a reconstruction nail for twenty. Operative time was 93 minutes (57–123). Blood loss was 200 l (150–350). There no intraoperative complications (fat embolus) excepting one tulip femur. Hospital stay was 23 days (8–55). Survival was 148 days (8–510) in patients with a frail metastatic tumour. Eight deaths occurred in patients with a fractured metastatic tumour (six within the first three postoperative weeks), two after preventive nailing. Weight bearing in living patients with a fractured femur was possible at 57 days (30–90). Only six patients required morphine in the early postoperative period. For the femurs with an isolated metastasis, the antalgesic effect of centromedullary nailing was significant (p< 0.05). There was a significant correlation between thee Tokuyashi score and mean survival. Mean survival in patients with a score < 3 was 2.1 months. Mean survival in patients with a score > 6 was 17 months.

Conclusion: Centromedullary nailing of the femur for metastatic fracture or fragilisation remains the treatment of choice for patients with short life expectancy. This technique limits pain while preserving independence as long as possible. The Tokuyashi score is correlated with patient survival. If this easy to establish score is too low (< 3), the survival can be expected to be insufficient for any surgical benefit.