Aims. The aims of this study were to establish whether composite fixation
(rail-plate) decreases fixator time and related problems in the
management of patients with infected nonunion of tibia with a segmental
defect, without compromising the anatomical and functional outcomes
achieved using the classical Ilizarov technique. We also wished
to study the acceptability of this technique using patient-based
objective criteria. Patients and Methods. Between January 2012 and January 2015, 14 consecutive patients
were treated for an infected nonunion of the tibia with a gap and
were included in the study. During stage one, a radical debridement
of bone and soft tissue was undertaken with the introduction of
an antibiotic-loaded cement spacer. At the second stage, the tibia
was stabilized using a long lateral locked plate and a six-pin monorail
fixator on its anteromedial surface. A corticotomy was performed
at the appropriate level. During the third stage, i.e. at the end
of the distraction phase, the transported fragment was aligned and
fixed to the plate with two to four screws. An iliac crest autograft
was added to the docking site and the fixator was removed. Functional
outcome was assessed using the Association for the Study and Application
of Methods of Ilizarov (ASAMI) criteria. Patient-reported outcomes
were assessed using the Musculoskeletal Tumor Society (MSTS) score. Results. The mean age of patients was 38.1 years (. sd. 12.7). There
were 13 men and one woman. The mean size of the defect was 6.4 cm
(. sd. 1.3). the mean follow-up was 33.2 months (24 to 50).
The mean external fixator index was 21.2 days/cm (. sd. 1.5).
The complication rate was 0.5 (7/14) per patient. According to the
classification of Paley, there were five problems and two obstacles
but no true complications. The ASAMI bone score was excellent in
all patients. The functional ASAMI scores were excellent in eight
and good in six patients. The mean MSTS composite score was 83.9%
(. sd. 7.1), with an
Aim. Bone metastases of the upper limb are a frequent complication of primary tumors. The aim of this study is to evaluate treatment and functional results of patients with prosthetic reconstruction of the proximal humerus. Method. Between 1975 and 2007, 67 patients were treated by resection of humeral metastasis and reconstruction with prosthesis. Cemented modular prostheses of the proximal humerus were implanted in 59 cases (all MRS Bioimpianti® prostheses), uncemented prostheses in 2 (HMRS® Stryker), 4 elbow Coonrad-Morrey prostheses (in 2 cases with bone allograft), 1 elbow custom-made cemented and 1 intercalary prosthesis (Osteobridge Merete®). Sites of primary tumors: kidney (23), lung (13), bone and unknow (7 each), liver and breast (3 each), bladder, endometrium, thyroid, soft tissues and nervous tissues (2 each), ovarium (1). Complications were evaluated and univariate analysis with actuarial Kaplan-Meier curves of implant survival was performed. Functional results were assessed with the
Aim. Aim of this study was to review surgical treatment of femural metastases, comparing nailing versus resection and prosthetic reconstruction. Method. Between 1975 and 2008 110 patients were surgically treated for metastatic disease of the femur. Prostheses were implanted in 57 cases (16 HMRS® Stryker, 38 MRP® Bioimpianti, 2 Osteobridge® and 1 GMRS®). In 53 patients femoral nailing was performed with different types of locked nails (32 Gamma, 14 Grosse-Kempft and 6 T2-Stryker®). Sites of primary tumor were breast (33 cases), kidney (18), lung (17), undifferentiated carcinoma (14), g.i. (8), bladder and prostate (5 each), endometrium and thyroid (3 each), skin (2), pheochromocytoma and pancreas (1 each). Indications to nails were given in patients with femoral metastasis and poor prognosis: multiple metastases, short free interval, unfavourable histotype, poor general conditions. Resection and prosthesis was preferred for patients with solitary metastasis, long free interval, favourable histotype, good general conditions or in whenever the extent of the lesion was not amenable to a durable internal fixation. Complications were analysed. Univariate analysis by Kaplan-Meier curves of implant and oncological survival was performed. Functional results were assessed with
