Purpose. We report our surgical management of a series of primary and metastatic tumours of the lumbosacral junction, highlighting different methods of fixation, outcome and complications. Method. Seven patients with primary and four with secondary tumours involving the lumbosacral junction underwent surgery. After tumour resection, iliolumbar fixation was performed in all but one case, using Galveston rods (4) or iliac screws (6). All constructs were attached proximally with pedicle screws. Cross links were used in all instrumented cases and autologous and allogenic bone graft applied. Results. There were no perioperative deaths. Mean operating time was 7.3 hours (range 3-18) and there was extensive blood loss (mean transfusion requirement 7.5 units, range 0-20). We estimate a transfusion requirement of approximately one unit per hour operating time. However, we noted no complications attributable to either blood loss or transfusions. Ambulation improved in 5, was unchanged in 5 and deteriorated in one. Neurological status deteriorated in 4 and remained static in the others. However in all but one case the neurological deficit was defined by the nature of proposed surgery. Mean survival from surgery for patients with metastatic disease was 9.5 months (3-18). At mean follow-up of 10 months (1-19 months), all patients with primary tumours were still alive without evidence of tumour recurrence. Extralesional excision, and therefore potentially curative surgery, was achieved in 4 cases where this was the primary goal of surgery (osteosarcoma, osteoblastoma, chordoma, embryonic rhabdomyosarcoma). There were no cases of metalwork failure. One patient has undergone revision surgery for pseudarthrosis. Conclusion. Sacral resection and iliolumbar reconstruction is a feasible treatment option in selected patients, offering potential cure. The fixation methods used by the authors restored lumbosacral stability, sufficient for pain relief and preserving ambulation and usually the predicted level of neurological function

Foreword. Silver coatings, used in many surgical devices, have demonstrated good antimicrobial activity and low toxicity. Oncological musculoskeletal surgery have an high risk of infection, so in the last decades, silver coated mega-prostheses have been introduced and are becoming increasingly widespread. Material and methods. We performed a retrospective analysis of 158 cases of bone tumors, primary or metastatic, treated between 2002–2014 with wide margins resection and reconstruction with tumoral implants. The average age was 59 years (range 11–78 years), all patients were treated by the same surgeon, with antibiotic prophylaxis according to a standard protocol. In 58.5% of patients were implanted silver-coated prostheses, in the remaining part, standard tumor prosthesis. Patients were re-evaluated annually and were recorded complications, with particular attention to infectious diseases. Results. The mean follow-up was 39.5 months. 23.4% of patients died at a median time of 34.9 months after surgery. 18.4% develop complications that required a new surgery, in 12.6% of cases due to infectious problems. Patients treated with silver-coated implants developed early infection in 2.2% of cases against the 10.7% of the patients treated with standard tumor prosthesis. This different among the two groups was statistically significant, while the percentage of late infections, occurred from 6 months after surgery, was similar between groups. Assuming a reduction of antimicrobial silver activity in the time, it was carried out a microscopic analyses [Fig. 1] of silver-coated prostheses explanted 82 months and 27 months after surgery. It confirmed an important degradation of the coating surface with almost complete absence of silver. Silver blood level, taken in a sample of patients, at different time after surgery, always showed values well below the threshold of toxicity, and no patient has never shown any sign of local or general toxicity secondary to silver [Fig. 2]. Discussion. Our study demonstrates that tumor silver-coated implants have a rate of early infection significantly less than traditional implants, while there were no differences in the rate of late infections, as described also in the literature. This likely is related to wear of the silver coating, which occurs on average around 2 years after implantation. Conclusion. We recommend to use silver–coated prosthesis as primary implants for limb salvage surgery, in primary or metastatic bone tumors, considering the absence of signs of toxicity and the lower rate of early infection

Aims

The aticularis genu (AG) is the least substantial and deepest muscle of the anterior compartment of the thigh and of uncertain significance. The aim of the study was to describe the anatomy of AG in cadaveric specimens, to characterize the relevance of AG in pathological distal femur specimens, and to correlate the anatomy and pathology with preoperative magnetic resonance imaging (MRI) of AG.