Our aim was to assess the value of external fixation in pathological fractures in selected patients.

During 2003–2008 we treated 35 patients with multiple myeloma or disseminated cancer, visceral metastases and pathological fractures with external fixation under sedation and local anaesthetic, because they were not fit for general anaesthesia. We used external fixation on 1 hip fracture, 1 fracture of the second metatarsal, 2 wrist fractures, 4 radial, 5 intertrochanteric, 1 subtro-chanteric, 12 fractures of the humerus, 1 ulna fracture, 4 femoral fractures, 3 tibial fractures and 1 femoral osteolysis. Operating times were 15–35 min, all patients were comfortable, cooperated well and they did not experience any pain during the procedure. In all cases XRT was applied either pre- or post-operatively.

On follow up (2–48 months) 4 of the patients were deceased. Fracture stabilization was adequate and X-rays confirmed porosis in 4 fractures; however, two lesions expanded further, despite proper adjuvant bio-pharmaceutical therapy. 5 patients impoved so we could operate them later to treat the fractures definitively. All individuals experienced pain relief, they were adequately mobilized and most function was restored, while there was no major problem with pin tract infections.

We suggest external fixation as a palliative treatment in patients with pathological fractures and multiple metastases, who don’t qualify for major surgery because of their critical illness. The later puts under local offer an excelent chance to fix fractures quikly, manage the pain and restore function without the risks of general anaesthesia

Aim: To study the outcome of the total excision of the clavicle focusing on the mobility of the upper limb.

Material and Method: We performed total claviculectomy in five patients with a neoplasm of the clavicle. This operation is requiring because there is a high risk of severe neurovascular damage due to the close vicinity of major neural and vascular elements. The growth was always excised en block with the clavicle to avoid local recurrence. Specimens were sent for histology, microbiology and genetic studies.

Results: Our patients had no complications so they could start rehabilitation soon. An abnormal scapular rhythm was noticed during shoulder abduction but normal motion was restored with exercises. The patients restored normal shoulder range of motion, they had no pain and there was no cosmetic problem. All patients were found and examined after 38±24 months. They maintained the excellent initial result and all they had returned to their former jobs and activities.

Discussion and Conclusions: Surgery for primary tumors of bone aims on the patient’s survival and on the sparing of a functioning limb. Any skepticism about total cla-viculectomy is not justified as this procedure, often followed by adjuvant treatments, gives the patient a chance to save his life while exercise helps restoring the normal mobility and function of the upper limb. The clavicle provides the insertion fields for several muscles, suspends and supports the arm. Our cases show that this bone is an accessory to the skeleton and its absence does not cause any functional problems.