Endoprosthetic replacement for aggressive benign and malignant bone tumors around the knee joint

The concept of limb-sparing surgery, or limb salvage, has gradually evolved over the past 25 years. Prior to this the basic principles of surgical oncology for the extremities consisted solely of determining the correct level at which to perform an amputation. Extremity amputation with wide or radical surgical margins was the primary treatment for bone and soft tissue malignancies involving the extremities until the 1970s. Advances in adjuvant treatments modalities, including chemotherapy and radiotherapy have improved survival and increased the role of limb salvage surgery. In addition, it has been shown that local control with limb salvage does not adversely affect the progression of the systemic disease. The use of endoprosthetic replacement as a method of reconstruction after major skeletal defects created after wide resection of tumor around the knee joint is a major progress that provides an immediate mobile joint after surgery. Twenty patients were included in this work. According to the staging system of Enneking et al., they were classified into 6 patients with an aggressive benign giant cell tumor [30%] and 14 patients with primary malignant bone tumors [70%]. These tumors were all located around the knee, 8 at proximal tibia [40%] and 12 at the distal femur [60%]. The six benign lesions were recurrent giant cell tumor after a pervious operative curettage and autogenous bone grafting or packing with bone cement in 4 of them [20%] and 2 [10%] were aggressive giant cell tumor grade 3 from the start. The 14 patients with primary malignant bony lesions, 3 of them were grade 1B and 11 were grade 11B. Wide resection was achieved followed by reconstruction by modular replacement endoprosthetic system. The follow up time was between 30 - 60 months with a mean of 46.3 months. The functional results of the procedure were rated as good to excellent with a mean of 83.3%. The end results of the procedure are justifiable for tumor surgery provides mobile knee joint with a stable limb and excellent functional end result. Complications occurred in 5 patients [25%] 4 of them necessitate reoperation. The use of endoprosthetic replacement as a method of reconstruction after major skeletal defects created after wide resection of tumor around the knee joint is a major progress that provided an immediate mobile joint after surgery. It has also obviated the need for prolonged immobilization in cast as with cases of biological reconstruction. This concept is important in such patients with short life expectancy but it is not free of complications and may need multiple surgeries

Short gamma nail versus dynamic Hip screw in the treatment of unstable trochanteric femoral fractures in the elderly. A comparative study

Trochanteric femoral fractures in osteoporotic bone pose a challenge to both the surgeon and the osteosynthesis device. The problem becomes compounded when the fracture is unstable. Thirty consecutive cases of unstable trochanteric fractures were treated surgically using two different methods of internal fixation, 13 cases being treated with the short gamma nail [GN] and 17 cases treated with the dynamic hip screw [DHS]. The average age in the GN group was 67.2 years, while being 66.8 years in the DHS group. Average follow-up was 11.6 months in GN group versus 12 months for the DHS group. Union occurred in all cases of GN [100%] while occurring in 12 of 17 of the DHS [70.6%]. A second procedure was not needed in any of the GN cases, while used in 5 of the DHS cases. Major complication as screw cut out occurred in 5 of the DHS cases with none in the GN cases. Final outcome based on clinical and radiologic data showed superior performance of the short gamma nail compared to the dynamic hip screw in the treatment of unstable trochanteric fractures

Surgical treatment of type I I congenital dysplasia of the tibia

Although congenital dysplasia of the tibia is a rare congenital abnormality, we report the result of treatment of eight cases. They were all type 2 according to Jones [1] and Kalamchi [2] with absence of the distal tibia. Treatment consisted of proximal fibula transfer to the lower end of the tibial stump followed by soft tissue release at the ankle and Ilizarov technique in order to correct the foot. This was also used to achieve leg lengthening to compensate for the discrepancy of length. The results were excellent as we achieved what we aimed for with very few complications