Purpose: Appropriate treatment of fractures of the acetabulum is well known but there is a risk of subsequent degeneration. Few reports of series reviewed after ten years are available. We report a series of 136 treated fractures of the acetabulum with a mean follow-up of 16 years.

Material and methods: Between 1972 and 1996, a total of 554 fractures of the acetabulum were treated. An independent operator reviewed 136 cases. The Judet Letournel classification was applied. Reduction was studied on the AP and 3/4 oblique views of the pelvis using the SOFCOT (November 1981) criteria. Intra- and postoperative parameters (blood loss, complications) were noted. Functional outcome was assessed with the Postel-Merle-d’Aubigné score.

Results: Orthopaedic treatment was used for 38% of the fractures. Forty-one percent were non-displaced and 54% were minimally displaced; 5% of patients had a contraindication for surgery. Reduction was achieved in 28% of the displaced fractures. Among the patients treated orthopaedically, 71% had a good or very good outcome. Anatomic reduction was achieved in 80%. The main complications were sciatic nerve injury (14%), heterotopic ossifications (18%), infection (5%) and intraarticular screws (5%). Good or very good outcome was achieved in 69%. A total hip arthroplasty was implanted in 19% at mean 8 years. Factors significantly related with poor outcome (p< 0.05) were age, posterior displacement, and surgeon experience. There was a good correlation between the function score and radiological signs of osteoarthritis.

Discussion: This is the longest follow-up reported in the literature. For operated patients, the percentage of good and very good outcomes was lower than in other series despite a good rate of anatomic reduction which thus is not a guarantee of good long-term outcome. Other prognostic factors found in the literature include fracture of the femoral head, type of fracture, and quality of the reduction. Long term follow-up remains essential for pertinent analysis of joint surgery.

Purpose: Pluridisciplinary therapeutic management is well defined for metastatic long bones. There are few prognostic criteria enabling an evidence-based choice between palliative surgery or abstention. We report a series of 24 metastatic femurs treated by palliative surgery and evaluated with the Tokuyashi score.

Material and methods: Sixteen women and eight men, mean age 71 years (5!-89) underwent centromedullary nailing of a metastatic femur (13/16 breast cancer in women, 20.24 other metastases. The Toskuhashi score was > 6 for 16/24 patients with pain unresponsive to morphine. Thirteen patients had fractured femurs and eleven had frail femurs due to the metastasis. Mean time to surgery was six days (1–15).

Results: A solid nail was used for four patients and a reconstruction nail for twenty. Operative time was 93 minutes (57–123). Blood loss was 200 l (150–350). There no intraoperative complications (fat embolus) excepting one tulip femur. Hospital stay was 23 days (8–55). Survival was 148 days (8–510) in patients with a frail metastatic tumour. Eight deaths occurred in patients with a fractured metastatic tumour (six within the first three postoperative weeks), two after preventive nailing. Weight bearing in living patients with a fractured femur was possible at 57 days (30–90). Only six patients required morphine in the early postoperative period. For the femurs with an isolated metastasis, the antalgesic effect of centromedullary nailing was significant (p< 0.05). There was a significant correlation between thee Tokuyashi score and mean survival. Mean survival in patients with a score < 3 was 2.1 months. Mean survival in patients with a score > 6 was 17 months.

Conclusion: Centromedullary nailing of the femur for metastatic fracture or fragilisation remains the treatment of choice for patients with short life expectancy. This technique limits pain while preserving independence as long as possible. The Tokuyashi score is correlated with patient survival. If this easy to establish score is too low (< 3), the survival can be expected to be insufficient for any surgical benefit.