Suspected Malignant Lesion of the Hip Resolves after Parathyroidectomy: Osteitis Fibrosa Cystica (or Brown Tumor): A Case Report.

We present a case of osteitis fibrosa cystica (OFC), also known as "brown tumor." A 55-year old female was admitted to the hospital with several months of right hip pain that was becoming more severe. A malignant lesion of the pelvis was suspected after initial imaging studies. Significant hypercalcemia led to a diagnosis of hyperparathyroidism and ultimately a benign parathyroid adenoma. Surgical excision of the adenoma resulted in full resolution of the tumor in her pelvis as well as her pain. It is important to keep OFC, or brown tumor, in your differential diagnoses when presented with a bone lesion.

Total Ankle Arthroplasty Using the Agility Stemmed Talar Revisional Component: Three to Eight Year Follow-Up.

BACKGROUND: Ankle fusion has been the traditional treatment of choice for failed total ankle arthroplasties or arthritic conditions that preclude the use of primary implants. A custom stemmed agility talar component was designed to be used in these conditions. METHODS: The first 30 cases by a single surgeon were reviewed at two intervals. The study was a retrospective chart review with data including ankle diagnosis, deformity, bone loss and other factors that may have an impact on ankle arthroplasty. American Orthopedic Foot and Ankle Society (AOFAS) hindfoot clinical rating scale scores were recorded and this group of patients was reviewed post operatively at a mean of 19 months (6-52), and at a mean of 54 months (37-94). The design rational will be discussed, as well as a brief description of the surgical technique. RESULTS: Retention of the implant was 93 percent at a mean of 19 months and 88 percent at a mean of 54 months. AOFAS scores were improved from 55 to 71 at the latest review. Complications included two slow healing lateral incisions, one deep infection, one fractured stem, and one below knee amputation secondary to acute femoral artery occlusion. CONCLUSION: Our experience with this custom implant has allowed salvage of many complex and difficult talar sided problems that otherwise would have required a fusion.

Treatment of thoracolumbar burst fractures with variable screw placement or Isola instrumentation and arthrodesis: case series and literature review.

BACKGROUND: The controversy of burst fracture surgical management is addressed in this retrospective case study and literature review. METHODS: The series consisted of 40 consecutive patients, index included, with 41 fractures treated with stiff, limited segment transpedicular bone-anchored instrumentation and arthrodesis from 1987 through 1994. RESULTS: No major acute complications such as death, paralysis, or infection occurred. For the 30 fractures with pre- and postoperative computed tomography studies, spinal canal compromise was 61% and 32%, respectively. Neurologic function improved in 7 of 14 patients (50%) and did not worsen in any. The principal problem encountered was screw breakage, which occurred in 16 of the 41 (39%) instrumented fractures. As we have previously reported, transpedicular anterior bone graft augmentation significantly decreased variable screw placement (VSP) implant breakage. However, it did not prevent Isola implant breakage in two-motion segment constructs. Compared with VSP, Isola provided better sagittal plane realignment and constructs that have been found to be significantly stiffer. Unplanned reoperation was necessary in 9 of the 40 patients (23%). At 1- and 2-year follow-up, 95% and 79% of patients were available for study, and a satisfactory outcome was achieved in 84% and 79%, respectively. These satisfaction and reoperation rates are consistent with the literature of the time. CONCLUSIONS: Based on these observations and the loads to which implant constructs are exposed following posterior realignment and stabilization of burst fractures, we recommend that three- or four-motion segment constructs, rather than two motion, be used. To save valuable motion segments, planned construct shortening can be used. An alternative is sequential or staged anterior corpectomy and structural grafting.