The ideal treatment of the unstable slipped upper femoral epiphysis (SUFE) is not clearly defined in the literature. Unstable SUFE occurs with less frequency than the stable SUFE. The incidence of unstable SUFE is between 14–25% of all SUFE’s. The literature reports a variety of accepted methods of treatment of the unstable SUFE, consequently, in Auckland there are various methods of treatment.

The unstable SUFE is at risk of development of avascular necrosis (AVN) of the femoral head. The reported incidence of AVN in unstable SUFE is between 15–50%. We expect that different treatment will influence the rate of AVN.

Our aim was to determine current practice and outcomes in Auckland. We reviewed the records and radiographs of all SUFE’s treated in Auckland from 2000–2007. In this time period there were 463 patients across the Auckland region, 109 of which had bilateral SUFE’s which allowed 572 treated hips to be followed. Over this time period there were 34 unstable SUFE representing 6% of treated hips. There was a difference in average weight, with unstable SUFE on average 10kgs lighter (60.5 vs 70.3kgs). Average time to surgery was 43 hours (range: 4–360hrs). Cases operated within 24 hours have a reduced rate of AVN (20%) compared to those operated after 24 hours (AVN 50%). Of the 34 cases, 13 cases had radiological evidence of AVN (35%). Of these there were 11 cases of pin penetration requiring further surgery. There was no difference in rate of AVN when comparing single screw to double screw fixation (SS 44% v DS 38%). There were 11 cases of pin penetration, 8 with single screw and 3 with double screw fixation.

Our review of unstable SUFE in Auckland has shown a difference in the weight of patients when compared to stable SUFE’s presenting from the same population. We have also found that cases operated on within 24 hours have a lower rate of AVN. Single screw fixation is more common than double screw fixation. There was no statistical difference in the rate of AVN but there was a higher rate of screw penetration when using a single screw fixation.

The proximal humerus is the third most common site for primary sarcoma of bone. Since the 1970’s the treatment of primary bone sarcoma has changed from amputation to limb salvage. This has been due to advances in chemotherapy, imaging and surgical techniques. The literature has shown that the survival after limb salvage is similar to that of amputation. The optimum method of reconstruction of the shoulder remains controversial. The aim of our study was to review the cases of primary bone sarcoma of the proximal humerus treated at Middlemore Hospital.

The New Zealand Bone Tumour Registry was searched for all lesions of the proximal humerus, with the diagnosis of chondrosarcoma, Ewing’s sarcoma or osteosarcoma. These records were reviewed for presentation status, biopsy, and type of reconstruct ion, chemotherapy, complications and recurrence. Outcomes measured in months of disease free survival and overall survival.

The Bone Tumour Registry identified 29 patients who were treated at Middlemore Hospital with the primary diagnosis of Ewing’s sarcoma, chondrosarcoma or osteosarcoma of the proximal humerus. Results were available for 26 of the 29 patients (90% follow-up). Of these 29 patients six had chondrosarcoma, four Ewing’s sarcoma and 19 osteosarcoma. The patients with chondrosarcoma had an average age of 50 years. three patients were treated with endoprosthesis (mean survival 48 months) and one with vascularised fibula reconstruction (status 27 months ANED). Of the four patients with Ewing’s sarcoma, two had surgical reconstruction, one with intercalary allograft reconstruction (status 96 months ANED) and one with endoprosthesis (status 84 months ANED). The 19 patients with osteosarcoma had an average age 27 years, 15 patients were treated surgically. Three had endoprosthetic reconstruction (mean survival 29 months), two allograft prosthetic composite reconstruction (mean survival 23 months), three vascularised fibula reconstruction (mean survival 217 months), one total shoulder replacement and proximal humeral autograft (status 68 months ANED), one hemiarthroplasty (status 21 months DOD) and one proximal humeral allograft (status 31 months ANED). 4 patients were treated with primary amputation (mean survival 55.25 months).

The mean overall survival for limb salvage surgery in our institution is 74 months compared to 55.25 months for amputation; this is consistent with the published literature. Function of a salvaged upper limb is superior to amputation. A salvaged limb is socially and emotionally more acceptable for patients than amputation. Limb salvage remains the priority in the treatment of primary bone tumours of the proximal humerus.