Introduction: We carried out a revision of Necrotizing Fasciitis diagnosed in our Hospital from January 2000 to July 2008. Necrotizing Fasciitis is an infection of soft tissues, caused in most of cases by Streptococcus pyogenes. It is a dangerous infection, because it progresses quickly, and it can lead to death due to systemic toxicity.

Materials and Methods: The study includes 18 patients afected by Necrotizing fasciitis treated in our Hospital from January 2000 until July 2008. In order to identify risk factors and clinical emergency signs, clinical detailed information was obtained for each patient.

Results: In 70% of the cases, Streptococcus pyogenes was found as the main germ involved in Necrotizing Fasciitis. In inicial stages, the patients complained of pain, heat, swelling, reddening and crepitation of the affected subcutaneous tissues. In advanced stages, patients went in a state of neurogenic shock. Specific antibiotical therapy was necessary in all cases. Surgical treatment was performed in 80 % of the cases, consisting of fascial aperture and debridement of devitalized tissues. In spite of the intensive medical and surgical treatments, 10% of the cases died.

Conclusion: We consider the suspicion and knowledge of Necrotizing fasciitis is crucial in order to diagnose early and properly this infection disease. Then we can be able to establish a precocious and suitable treatment which can avoid the potentially fatal outcome.

Introduction: Aggressive fibromatosis is a benign but locally aggressive process. It arises from musculo-aponeurotic tissues, and invades locally without respect for tissue planes, surrounding vessels and nerves, which makes treatment of local recurrences difficult.

Aims: Our aim is to review our experience in the management of aggressive fibromatosis, focussing on the cases of multiple recurrences, as well as to evaluate the need for disabling surgery.

Material and methods: We present the series of 33 patients (15 male and 18 female) diagnosed of aggressive fibromatosis treated between 1993 and 2003; the follow-up period was no less than two years. The locations were shoulder girdle (8), lower extremity (8), upper extremity (6), gluteus (5), paravertebral (4) and thorax (2). There were 6 cases with 3 or more episodes of local recurrences; in these cases, depending on location and size, and considering high surgical morbidity, associations of radiotherapy, chemotherapy and hormone therapy were given, avoiding disabling surgery.

Results: With an average follow-up of 32 months (25 to 50), there were no deaths and, in the 6 cases of multiple recurrences, there were no amputations. The control MRI demonstrated stability of the process in 5 out of 6 cases, and minimum growth without clinical correlation in the other one. In the other 27 cases, there were 14.8% surgical treated local recurrences, with no need for amputation.

Conclusion: We consider that cases of multiple recurrences of aggressive fibromatosis benefit from adjuvant treatment (radiotherapy, chemotherapy and hormone therapy), avoiding disabling surgery, which is unnecessary following our criteria. This requires strict clinical and radiological control.

Introduction: Synovial sarcoma ranks as the fourth most common sarcoma, but it is uncommon in the hand. Most Synovial Sarcomas arise in para-articular soft tissue such as tendon, tendon sheath and bursa adjacent to the large joints capsules. Arround 60–70% of these tumors involve lower extremity and they frequently affect knee, thigh and foot. The reported incidence for Synovial Sarcoma in hand is only 8.5%.

Material and methods: We carried out a retrospective study of 6 hand and forearm sarcomas, of a series of 35 synovial sarcomas surgically treated in our center from 1991 to 1997, with a 6 years follow up (3y.–11y.). 3 patients were male and 3 female, with a mean age of 54 years at the moment of initial diagnosis. Histologically all of them were synovial sarcomas: 4 monophasic and 2 biphasic. The inmunochemistry showed that the neoplasic cells were positive for vimentin, epithelial membrane antigen and cytokeratin. 2 of them were localized in the palmar aspect of the hand (2 ulnar cases and 2 eminence tenar cases), an 2 cases were dorsal. 2 cases were misdiagnosed as benign lesions and treated with tumor excision at another center.

Results: Primary treatment consisted of radical local excision of synovial sarcoma of the hand. 5 patients received adjuvant chemotherapy with CYVADIC and radiotherapy. 2 cases of recurrence received a second surgical treatment with forearm amputation. The mean time to recurrence was 12 months. At the end of the follow-up 3 patients developed metastatic disease and 2 of them died.

Discussion: Synovial Sarcoma in hand is a highly malignant tumor; due to its morphology they can be misdiagnosed as benign lesions such as aggressive fibromatosis or ganglion cysts. If we diagnose a soft tissue tumor in hand we must practice complementary tests to achieve early diagnosis. It is also important the multidisciplinary treatment of Synovial Sarcoma.

Introduction and purpose: The results of hemiarthroplasty for the treatment of complex proximal humerus fractures are controversial since there are wide variations across series. In what follows, we shall present our experience and results with the implants we use, with a minimum follow-up of one year.

Materials and methods: 87 prostheses were revised (hemiartroplasty with cemented Neer II endoprosthesis) with a minimum follow-up of one year (1 to 10); 74 females and 13 males, 53 right and 34 left, with a mean age of 73.3 years (range: 51 – 82). Indications included three-part fractures (15 cases), four-part fractures (66) and fracture-dislocation (6). All patients were put on a postop customized standardized physical therapy program.

Results: The Constant test was performed after 3, 6 and 12 months postop, with a mean result of 44.57 points after 3 months, 49.52 after 6 months and 64.37 after 12 months. 90% of patients had either no pain or occasional pain and 85% of them subjectively described their condition as very good. Two patients were revised: one as a result of a lysis in his lesser tuberosity and the other because of a painful implant. There were two instances of a periprosthetic fracture and three infections (2 late ones and a post-fracture one).

Conclusions: Although these results might seem poor, it should be emphasized that heimarthroplasty led to a predictable absence of pain and to a perception by the patient that the result obtained was very good. Even if it is true that certain limitations were observed in terms of function and strength, patients were able to perform many of their daily life activities and gain a substantial degree of independence, albeit with certain restrictions. For this reason we consider the technique described as the procedure of choice for these types of fractures.