Bloodless field in limb musculoskeletal tumours’ surgery has great value as it facilitates resection and reconstructions without excessive bleeding.

40 large bone or soft tissue tumors located in upper (n=4) and lower limbs (n=36) were resected and reconstructed in bloodless surgical field achieved by a new device, an elastic silicone ring (S-Mart, OHK Medical Device). Proper size of it is chosen between items of different diameter, length and elasticity depending on their measurements and BP. Our goal was safe and sufficient blood pressure for bloodless operation. In tumours, esh-mark and any pressure on the mass results in microscopic spread. We rolled the ring along the limb, starting from digits and exsanguinated the limb raising it above the tumour to avoid crushing it. If tumours extend too proximally to hip and shoulder we cannot use tourniquet because cuffs are wide enough to allow proximal extension of the incision. The elastic ring we used, is too narrow (Φ< 20cm) and proved of utmost importance in large, bleeding growths helping tumour elimination and limb salvaging. The ring was applied from 18–120 minutes created completely bloodless surgical field thus facilitating and speeding up the operation. The time needed for application was shorter than for pneumatic tourniquet (< 10sec). After removing the elastic ring we noticed neither BP drop nor tumour spread or complications of skin and neurovascular elements pressure.

Thus we conclude that limb ischaemia achieved with special elastic rings have benefits and may be considered as safe in oncological surgery.

Our aim was to assess the value of external fixation in pathological fractures in selected patients.

During 2003–2008 we treated 35 patients with multiple myeloma or disseminated cancer, visceral metastases and pathological fractures with external fixation under sedation and local anaesthetic, because they were not fit for general anaesthesia. We used external fixation on 1 hip fracture, 1 fracture of the second metatarsal, 2 wrist fractures, 4 radial, 5 intertrochanteric, 1 subtro-chanteric, 12 fractures of the humerus, 1 ulna fracture, 4 femoral fractures, 3 tibial fractures and 1 femoral osteolysis. Operating times were 15–35 min, all patients were comfortable, cooperated well and they did not experience any pain during the procedure. In all cases XRT was applied either pre- or post-operatively.

On follow up (2–48 months) 4 of the patients were deceased. Fracture stabilization was adequate and X-rays confirmed porosis in 4 fractures; however, two lesions expanded further, despite proper adjuvant bio-pharmaceutical therapy. 5 patients impoved so we could operate them later to treat the fractures definitively. All individuals experienced pain relief, they were adequately mobilized and most function was restored, while there was no major problem with pin tract infections.

We suggest external fixation as a palliative treatment in patients with pathological fractures and multiple metastases, who don’t qualify for major surgery because of their critical illness. The later puts under local offer an excelent chance to fix fractures quikly, manage the pain and restore function without the risks of general anaesthesia