Aim

Synovial sarcoma (SS) is a malignant soft tissue sarcoma with a poor prognosis because of late local recurrence and distant metastases. To our knowledge, no studies have minimum follow-up of 10 years that evaluate long-term outcomes for survivors.

Introduction: The treatment of the recently ruptured Achilles tendon is still controversial. Surgical procedures are commonly considered to restore excellent functional capacity and suffer low re-rupture rates, but are potentially associated with significant complications like wound infection and paraesthesia. Recent studies report very good results with a conservative treatment in rigid casts. Our aim was to evaluate a new method of functional and conservative treatment using immobilisation in an articulated cast.

Patients and Methods: Between March 1998 and August 2005, 12 women and 45 men with an average age of 45 (24–73), underwent a functional and conservative treatment for a recently ruptured Achilles tendon. After an immobilisation with a cast in equinus for 10 days, the patients were authorised to walk with full weight-bearing, protected by a commercial orthosis (VACO®ped, OPED). The equinus angle was set at 30° plantar flexion until the end of week 3, and at 15° until the end of week 4. At the 5th week the system was unlocked to allow ankle mobilisation of 30-15-0°, and at 30-0-0° at the seventh week. The orthosis was removed after 8 weeks. All patients had follow-up examinations up to 12 months after the trauma. The first 30 patients underwent a clinical examination and muscular testing with a Cybex isokinetic dynamometer at 6 and 12 months. In June 2006 all 57 patients were contacted and received a questionnaire. Their subjective opinions of the outcome, any change in their sport activities and eventual late complications were investigated. We evaluated the questionnaire and medical records using a scoring system based on the Leppilahti Ankle Score.

Results: After one year there was not any difference in the motion of the ankle in comparison with the healthy side. There was no substantial calf amyotrophy and we found very little difference in muscular capacity. The average overall satisfaction with the outcome was 8.1 out of 10. We observed 5 complete re-ruptures (9%), 2 partial re-ruptures and 1 deep venous thrombosis complicated by pulmonary embolism. We observed few minor skin complications.

Conclusions: The present treatment resulted in good to excellent functional results in most of the cases. It requires an active participation of the patient and a systematic medical follow-up during the first 6 months. The complication rate is acceptable. We think that early ankle mobilisation in the dynamic cast promotes better functional results than a rigid immobilisation technique.

There is a place for conservative functional treatment in the acute rupture of the Achilles tendon. But prospective comparison with modern surgical techniques, like minimal invasive suture, is still required, especially in patients with high functional demand.

Background: Extracapsular fractures of proximal femur are known to have a significatively high morbidity and mortality rate at one year, and this rate is higher in case of non operative treatment. The standard gamma nail (SGN) was originally designed to provide a stable implant which allows early mobilisation and weight bearing of the elderly patients. The design of SGN however, appeared to be associated with intraoperative or postoperative femoral shaft fractures in up to 17%, requiring further surgery and compromising the outcome in these elderly patients. The trochanteric nail (TGN) was developed to overcome the problems encountered with the use of the SGN.

We report our experience in the use of the TGN in the treatment of extracapsular fractures of proximal femur. Methods: Between December 1999 and January 2001, eighty-seven consecutive patients with an extra-capsular fracture of the femur (in one case bilateral) and one patient with a proximal femoral metastasis were treated with a TGN. Nine patients died within four months of the operation and 3 were lost at follow-up. Seventy-five patients, for a total of 76 fractures were followed clinically and radiographically until the end of treatment, for a mean follow-up period of 10 months. Results: In none of 88 cases did an intraoperative shaft femur fracture occur, nor was this complication observed in the 76 femurs evaluated at follow-up. Postoperative infection was never found and union was achieved in every case. Two cases of cutting-out were reported and both were caused by incorrect placement of implant. Only nine patients (12%) required two crutches or walker at the last follow-up. Conclusion: The TGN is a promising alternative for the treatment of extracapsular fractures of the proximal femur. This implant enables the surgeon to treat most of intertrochanteric and high subtrochanteric fractures with a less invasive technique, and permits early mobilisation and unprotected weight-bearing, without the complications observed with the use of the SGN.