Introduction

Patients (2.7M in EU) with positive cancer prognosis frequently develop metastases (≈1M) in their remaining lifetime. In 30-70% cases, metastases affect the spine, reducing the strength of the affected vertebrae. Fractures occur in ≈30% patients. Clinicians must choose between leaving the patient exposed to a high fracture risk (with dramatic consequences) and operating to stabilise the spine (exposing patients to unnecessary surgeries). Currently, surgeons rely on their sole experience. This often results in to under- or over-treatment. The standard-of-care are scoring systems (e.g. Spine Instability Neoplastic Score) based on medical images, with little consideration of the spine biomechanics, and of the structure of the vertebrae involved. Such scoring systems fail to provide clear indications in ≈60% patients.

Introduction and Objectives: Cryopreservation as a meniscus conservation method affects cellularity to a lesser degree than simple freezing. Recent studies have shown that freezing alters meniscus ultrastructure. The effects of cryopreservatioin on the meniscus collagen net has not been so extensively studied. The aim of this study was to determine if cryopreservation alters meniscus ultrastructure and cellularity.

Materials and Methods: We obtained 10 external menisci for the purpose of studying their cellularity and collagen structure before and after cryoprservation at −180°C. We analyzed the architecture of the meniscus collagen using transmission electronic microscopy and assessed the degree to which this was altered according to a previously determined scale. We measured collagen fibers in transverse and longitudinal sections, and also calculated the percentage of cells that survived cryopreservation.

Results: Cryopreserved menisci averaged 4.8 points and the control menisci 4.1 (p< 0.17). In the cryopreserved menisci the collagen fibers in longitudinal section had a mean length of 12.61 nm and in the control menisci 13.38 nm (p=0.34), whereas in transverse sections the average was 15.48 nm and 16.7 nm respectively (p=0.41). The percentage of cells that survived cryopreservation went from 3.99 to 53.57%.

Discussion and Conclusions: Cryopreservation does not alter meniscus ultrastructure. Cell survival is highly variable. Results suggest that cryopreservation would be a more appropriate method than freezing at −80°C for the preservation of meniscal allografts.

Introduction and Objectives: The increase in hip replacement surgery in recent years as a consequence of the aging population and a greater demand placed on joints by our current lifestyle has caused an increase in related complications. The rate of intraoperative periprosthetic fractures is between 0.8 and 2.3%, and postoperative fracture rates reach 0.1% in some studies. This type of fracture is usually complex, and treatment is almost always quite difficult.

Materials and Methods: This study concentrates on peri-prosthetic hip fracture as a postoperative complication examining cases treated during the last 5 years. We have included cases of cemented and cementless partial and total arthroplasty. In this study, we did not include intra-operative fractures (secondary to surgical manipulation, as a result of reaming, cementing, or impaction of prosthetic components) because an irregular clinical history was associated with such cases, only reflecting those which required some type of synthesis, particularly cer-clage. The Johanson scale and the AAOS classification were used to classify fractures.

Results: Of 30 periprosthetic fractures recorded during the study period, 11 patients (36.7%) were males and 63.3% were female. Of fractures of the femoral diaphysis, more than half were Johanson Type II. Only one case involved the acetabulum. Nearly 17% required revision of some prosthetic component, and about one-third could be resolved orthopaedically. Of cases treated surgically, most complications were related to the surgical wound.

Discussion and Conclusions: The type of treatment used depends on various factors, such as type of fracture and fracture line, patient age, prosthetic loosening, etc. Individualised treatment is therefore the standard. We have observed no abnormalities in bone healing. Although this type of fracture is fortunately rare, we consider good preoperative planning and a thorough postoperative follow-up to be very important for the correct resolution of this difficult problem.