Treatment of aggressive benign bone lesions with curettage, burring, cementation and plate augmentation is a widely accepted treatment. We have used the above method using a locked plate (rather than conventional), facilitating stability and early mobilisation. We hypothesise that this is an alternative to megaprosthetic joint replacement, and provides acceptable functional outcomes at follow-up. Patients with peri-articular aggressive benign bone lesions of the lower limb were treated with marginal excision, intra-lesional curettage, burring and cementation. This was augmented with a locked plate of varying designs. Where feasible, liquid nitrogen was used as an adjunctive treatment. Functional outcome was evaluated at follow-up using the Musculoskeletal Tumour Society Score (MSTS). Routine X-rays were performed at follow up to determine if there was any radiographic evidence of recurrence or any complications.Background
Methods
Prevalence. Periprosthetic fractures around a total knee are uncommon but not rare; various large database studies suggest 0.3–2.5%. Patients at highest risk are typically older patients and those with poor quality bone from various etiologies. Supracondylar femur fractures are often associated with a high stress zone at the metaphysis/diaphysis junction near the superior edge of femoral component. Etiology. Low energy trauma is the most common preceding event as most of these occur in patients with poor bone quality. Elderly patients are at particular risk because standing-height falls generate enough energy to create fractures. Given the durable nature of most modern TKA designs the prosthesis is usually fixed well. Goals. The goals of treatment are typically fracture union, avoidance of infection, avoidance of stiffness, and maintenance of overall limb alignment. Recent gains in knowledge indicate the need to attain maximal distal fragment fixation in order to achieve the surgical goals. Correct alignment, length and rotation are often best assessed with a combination of radiographic images and intra-operative clinical inspection. Modern internal fixation principles emphasise the need to minimise stripping/devascularization of comminuted zones. Options. Three major treatment options exist for supracondylar fractures. Retrograde nails have advantages in that they are tissue-friendly and are mechanically advantageous in the face of medial comminution. Difficult to use with most posterior stabilised TKA (box). There are limited distal fixation options and malalignment is often hard to avoid. With plating the distal fixation can be maximised and there is less risk for malalignment. Typically requires more soft tissue dissection.
Fractures of distal tibia are common and often present with dilemma of appropriate and safe management. The use of locking plates has changed the way these fractures have been managed as it avoids extensive soft tissue dissection and periosteal stripping. The aims of this study were to look at the results of stabilization and analyse the complications of fractures of distal tibia treated with
