Gaining stable fixation in cases of recalcitrant non-unions can be challenging. These cases can be accompanied by a segmental bone defect and disuse osteopenia. One strategy to gain stable fixation is the use of allografts. Both cortical struts and intramedullary fibular allografts have been used for this purpose in the femur, tibia and humerus. The present study aims to compare the mechanical properties a locking plate, an intramedullary fibular strut allograft and a cortical strut allograft in a femur model of segmental bone defect.

A transverse mid-shaft osteotomy was performed in fifteen third generation large composite femurs. Twelve millimeters of bone was resected to create a segmental bone defect. Fixation was undertaken as follows: Construct F (Fibula): Lateral Non Locking plate and Intramedullary Fibula Allograft Construct LP (Locking Plate): Lateral Locking Plate Constrcut S (Strut): Lateral Non-Locking Plate and Medial Cortical Strut Allograft Axial, Torsional and Bending Stiffness as well as Load-to-Failure were determined using an Instron 8874 materials testing machine.

Overall, construct S was the stiffest, construct F intermediate and construct LP the least stiff. Specifically, the S construct was significantly (p< 0.05) stiffer than the two other constructs in the axial, coronal plane bending, sagital plane bending and torsional modes. Construct F was significantly stiffer than construct LP in the axial and coronal plane bending modes only. Both the S construct (6108 N) and the F construct (5344 N) had a greater Load-to-Failure than the LP construct (2855 N) (p=0.005 and 0.001 respectively).

The construct with a lateral non-locking plate and a medial allograft strut was stiffer and had a higher load-to-failure than the construct consisting of a stand-alone locking plate. An intramedullary fibular allograft with a lateral non-locking plate had intermediate characteristics. Other factors, such as anatomic and biologic considerations need to be considered before choosing one of the above constructs. The allograft procedures should only be used once soft tissue coverage has been obtained and any infection eradicated.

Acute total knee dislocations are uncommon injuries for which some surgeons use artificial ligaments as their choice of graft for reconstruction. The goal of this study is to evaluate on a short and long term basis the stability and function of the LARS reconstructed knee. Flexion ROM was the only parameter which showed significant difference (p< 0.05) between subgroups. Therefore this treatment option for dislocated knee reconstruction seems to give good and lasting results even though patient’s quality of life may suffer.

Although a variety of options have been proposed for the treatment of knee dislocations, the optimal one remains controversial. Allografts and autografts have both been used for reconstruction of the cruciate ligaments. The purpose of this study is to evaluate acute reconstruction of both cruciate ligaments using Ligament Advanced Reinforced System (LARS) artificial ligaments.

We reviewed treatment of forty-eight acute knee dislocations. All patients had reconstruction of both cruciate ligaments with LARS ligaments. Patients were assed using SF-36, Lysholm and IKDC questionnaires as well as a physical exam. Stability of the reconstructed knee was evaluated radiologically using TELOS instrumentation. The controlateral knee was used as reference.

The forty-eight patients were subdivided into four groups of post-operative intervals ranging from six months to seven years. The average ROM was 120°of flexion and −1.4° of extension. The differential average TELOS for LCA, LCP at 30° and LCP at 90° were respectively 2.9 mm, 2.8 mm, 6.9 mm. and their average Lysholm, SF-36 and IKDC scores were 72.0, 72.5, 53.5. Statistical results showed no significant difference (p> 0.05) between subgroups in terms function, laxity and extension but did in flexion.

Our data show that patients treated by this method can regain a functional knee in terms of motion, stability and functional status and does not seem to deteriorate with time.

Knee reconstruction with artificial ligaments shows promising results at short and longer term even though it seems to affect quality of life in this population.

Financing: This study was partially financed by JK Orthomedic Inc.

A prospective evaluation of the functional status and quality of life of patients undergoing surgery for long bone and acetabular metastases was performed. Sixty-nine patients were enrolled in the study. IM nailing and prosthetic replacement were the most common methods of treatment. Results were assessed using the MSTS 1987, MSTS 1993, TESS and SF-36 pre-op and then at six and twelve weeks post-op. There was a significant improvement in all of these parameters. The need for pain medication also decreased significantly. These results show surgical treatment of bone metastases can be benificial to patients with a short life expectancy.

The purpose of this study was to objectively assess the benefits of surgical treatment of bone metastases in the first three months post-operatively.

This is the first prospective study to evaluate the impact of surgery on the quality of life and function of patients burdened by metastases to the appendicular skeleton.

Sixty-nine patients gave their informed consent to be followed prospectively. Patients were administered the SF-36, MSTS 1987, MSTS 1993 and TESS questionnaires pre-op, at six weeks and three months post-op.

Average age was sixty-one years. Average follow-up was six months with 71% of patients deceased at the latest follow-up. Thirty-five patients had a pathological fracture and thirty-four had an impending fracture. IM Nailing was performed in thirty-six patients, prosthetic replacement in twenty and various other methods of stabilization in the thirteen other cases. Complications occurred in 25% of patients. There was a statistically significant improvement in the MSTS 1987 (from 13,6 to 22,8), MSTS 1993 (21,7 to 51,7), TESS (37,7 to 67,7) and pain medication use in the first three months post-op. SF-36 physical component scores improved significantly at six and twelve weeks while mental component scores improved significantly only at twelve weeks post-op.

Our data shows that surgical treatment of metastatic disease to long bones improves functional status and quality of life in a relatively short time frame. This is significant in a group of patients suffering from advanced neoplasia.

This study suggest interesting benefits in the overall well-being of patients treated surgically for bone metastases.

Funding: Funding was received from CHIR and FREOM.

A retrospective study was performed to evaluate the results of proximal humeral replacement prosthesis in the oncologic setting. Following tumour resection and implantation of the prosthesis, the soft tissues around the shoulder were either sutured directly to the prosthesis (three cases) or a dacron capsuloplasty was performed (five cases). Emphasis was on assessing shoulder instability. Eight patients were availaible for the study. Three patients needed to be re-operated for instability. Average instability rating on the ASES visual analog scale was 3,2/10. We conclude the prosthetic instability can be a significant problem for these patients.

The purpose of this study was to assess the results of oncologic proximal humeral prosthesis with a focus on shoulder instability.

Following limb-salvage procedures of the shoulder girdle, reconstruction of the soft-tissues to obtain prosthetic stability can be a major challenge.

A retrospective study of patients that underwent oncologic shoulder replacement. Results were evaluated using the SF-36 questionnaire, the MSTS 1987 and 1993 scales as well as the Standardized ASES method for assessement of shoulder function, including the visual analog scale for instability.

Nine patients were still living and eight of them were able to participate in this study. Average follow-up was seventy-three months. In five cases a capsuloplasty was performed using a dacron vascular prosthesis. In the remaining cases the capsule, rotator cuff or deltoid were sutured directly to the prosthesis.

Average instability rating was 3,2/10 using the visual analog scale. Three patients were reoperated for instability. Two had a failed soft tissue repair with inferior dislocation of the prosthesis and one had recurrent anterior dislocation.

Average MSTS 1987 and 1993 scores were 19,9 and 18,9 respectively.

SF-36 scores were significantly lower than Canadian standards in the physical functioning, role physical and mental health domains.

Our data show a significant rate of instability related problems following prosthetic replacement of the proximal humerus in cases of limb salvage. We were unable to indentify specific strategies to prevent this.

Further research is needed to determine optimal soft tissue reconstruction for oncologic procedure about the shoulder.